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NPI Code Detail

MEDICARE: DEBRA L RET PT

MEDICARE: DEBRA L RET 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
1225100000XPhysical Therapist40QA00348700NJ

General Provider Information

NPI Number : 1356467377
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBRA L RET PT
Provider Business Mailing Address
First Line : 3543 DUTCH MILL RD
Second Line :
City : NEWFIELD
State : NJ
Zip : 08344-5559
Country : US
Telephone Number : 856-697-1893
Fax Number :
Provider Business Practice Location Address
First Line : 2250 HICKORY RD
Second Line : SUITE 240
City : PLYMOUTH MEETING
State : PA
Zip : 19462-1047
Country : US
Telephone Number : 610-834-1122
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2007
Last Update Date : 07/08/2007

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