MEDICARE: SCANLON PHYSICAL THERAPY INC.

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	174400000X	Specialist	7536	MA

General Provider Information

NPI Number	:	1306018627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCANLON PHYSICAL THERAPY INC.

Provider Business Mailing Address
First Line	:	722 CENTRE ST
Second Line	:
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-2516
Country	:	US
Telephone Number	:	617-522-5550
Fax Number	:	617-983-0884

Provider Business Practice Location Address
First Line	:	722 CENTRE ST
Second Line	:
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-2516
Country	:	US
Telephone Number	:	617-522-5550
Fax Number	:	617-983-0884

Authorized Official
Title or Position	:	PHYSICAL THERAPIST/ PRESIDENT
Name	:	MR. WILLIAM F SCANLON
Credential	:
Telephone Number	:	617-522-5550

Provider Enumeration Date	:	03/26/2008
Last Update Date	:	03/26/2008

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