MEDICARE: MR. JEFFREY S MANNHEIMER PHD, 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	40QA00083100	NJ

General Provider Information

NPI Number	:	1275533614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY S MANNHEIMER PHD, PT

Provider Business Mailing Address
First Line	:	336 SHADY BROOK DR
Second Line	:
City	:	LANGHORNE
State	:	PA
Zip	:	19047-8031
Country	:	US
Telephone Number	:	215-968-5981
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 FRANKLIN CORNER RD
Second Line	:	SUITE 103
City	:	LAWRENCEVILLE
State	:	NJ
Zip	:	08648-2526
Country	:	US
Telephone Number	:	609-896-9054
Fax Number	:	609-896-9059

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	07/08/2007

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