MEDICARE: MR. JOHN A RUNFOLO 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	40QA00705600	NJ

General Provider Information

NPI Number	:	1194817858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN A RUNFOLO PT

Provider Business Mailing Address
First Line	:	50 SETON HALL DR
Second Line	:
City	:	FREEHOLD
State	:	NJ
Zip	:	07728-8876
Country	:	US
Telephone Number	:	732-845-0219
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 MULE RD STE 1
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08757-6460
Country	:	US
Telephone Number	:	732-569-6556
Fax Number	:

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

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	09/04/2020

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