MEDICARE: MRS. ELLEN T POVEROMO PT

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	5499	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174514467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELLEN T POVEROMO PT

Provider Business Mailing Address
First Line	:	22 ARLINGTON AVE
Second Line	:
City	:	BEVERLY
State	:	MA
Zip	:	01915-1002
Country	:	US
Telephone Number	:	978-927-2528
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 CUMMINGS CTR
Second Line	:	SUITE 121Q
City	:	BEVERLY
State	:	MA
Zip	:	01915-6115
Country	:	US
Telephone Number	:	978-927-0907
Fax Number	:

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

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	01/05/2011

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