MEDICARE: CHARLES PETER MEDWYNTER

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	013626	NY

General Provider Information

NPI Number	:	1306071360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES PETER MEDWYNTER

Provider Business Mailing Address
First Line	:	2802 ALBEMARLE RD FL 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-5037
Country	:	US
Telephone Number	:	718-812-7082
Fax Number	:

Provider Business Practice Location Address
First Line	:	2802 ALBEMARLE RD FL 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-5037
Country	:	US
Telephone Number	:	718-812-7082
Fax Number	:

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

Provider Enumeration Date	:	05/20/2009
Last Update Date	:	04/18/2011

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