MEDICARE: MS. MARSHA ELLEN BERGER GRANT MS PT OCJ

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	PT005482L	PA

General Provider Information

NPI Number	:	1184624868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARSHA ELLEN BERGER GRANT MS PT OCJ

Provider Business Mailing Address
First Line	:	676 DE KALB PIKE
Second Line	:	STE 205
City	:	BLUE BELL
State	:	PA
Zip	:	19422-1223
Country	:	US
Telephone Number	:	610-270-0380
Fax Number	:	610-270-0874

Provider Business Practice Location Address
First Line	:	1500 HORIZON DR
Second Line	:	STE 102E
City	:	CHALFONT
State	:	PA
Zip	:	18914-3966
Country	:	US
Telephone Number	:	215-712-0300
Fax Number	:	215-712-9040

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	07/08/2007

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