MEDICARE: ROBERT HEWGLEY 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	PT007356	GA

General Provider Information

NPI Number	:	1306919675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT HEWGLEY PT

Provider Business Mailing Address
First Line	:	8259 WICKER AVE
Second Line	:
City	:	SAINT JOHN
State	:	IN
Zip	:	46373-8878
Country	:	US
Telephone Number	:	219-365-6553
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 ASBURY CIR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30368-0001
Country	:	US
Telephone Number	:	404-727-2946
Fax Number	:

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

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	12/20/2007

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