MEDICARE: ERUM N KHAN 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		MI

General Provider Information

NPI Number	:	1174556039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERUM N KHAN PT

Provider Business Mailing Address
First Line	:	227 HADLEIGH DR
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08003-1936
Country	:	US
Telephone Number	:	215-530-2475
Fax Number	:

Provider Business Practice Location Address
First Line	:	2040 E ALLEGHENY AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-3817
Country	:	US
Telephone Number	:	215-278-2229
Fax Number	:

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	11/04/2016

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