MEDICARE: MR. JASON JACK GUARNERI MPT, SCS, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	J1 - 0001975	DE
2	225100000X	Physical Therapist	PT018523	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	91128101	OTHER	CAREFIRST
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1134233398	OTHER	CHAMPUS TRICARE
4	5070-0049	OTHER	CAREFIRST
5	1990451	OTHER	PABS
6	2860990000	OTHER	IBC AMERIHEALTH

General Provider Information

NPI Number	:	1134233398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JASON JACK GUARNERI MPT, SCS, ATC

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 W BALTIMORE PIKE
Second Line	:	SUITE 103
City	:	WEST GROVE
State	:	PA
Zip	:	19390-9313
Country	:	US
Telephone Number	:	610-869-2200
Fax Number	:	610-869-2311

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	01/15/2014

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Directions to “ MR. JASON JACK GUARNERI MPT, SCS, ATC” Practice Location

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