MEDICARE: MR. AUGUSTINE CIARDULLO 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	PT006311L	PA

General Provider Information

NPI Number	:	1275612988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AUGUSTINE CIARDULLO P.T.

Provider Business Mailing Address
First Line	:	158 BISHOP DR
Second Line	:
City	:	ASTON
State	:	PA
Zip	:	19014-1314
Country	:	US
Telephone Number	:	610-459-5486
Fax Number	:	215-334-4531

Provider Business Practice Location Address
First Line	:	2410 S BROAD ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19145-4418
Country	:	US
Telephone Number	:	215-334-4400
Fax Number	:	215-334-4531

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

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	07/08/2007

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