MEDICARE: CECILLE MCLARNON P.T.

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	40QA01156300	NJ
2	225100000X	Physical Therapist	027994	NY

General Provider Information

NPI Number	:	1184653446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CECILLE MCLARNON P.T.

Provider Business Mailing Address
First Line	:	156 LIBERTY ST APT 8
Second Line	:
City	:	LITTLE FERRY
State	:	NJ
Zip	:	07643-1768
Country	:	US
Telephone Number	:	201-233-7839
Fax Number	:

Provider Business Practice Location Address
First Line	:	156 LIBERTY ST APT 8
Second Line	:
City	:	LITTLE FERRY
State	:	NJ
Zip	:	07643-1768
Country	:	US
Telephone Number	:	201-233-7839
Fax Number	:

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

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	07/24/2007

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