MEDICARE: MR. THOMAS D KEARSLEY 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	40QA00985400	NJ

General Provider Information

NPI Number	:	1376510040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS D KEARSLEY PT

Provider Business Mailing Address
First Line	:	25 N BOSTON AVE
Second Line	:	APARTMENT 3
City	:	ATLANTIC CITY
State	:	NJ
Zip	:	08401-3534
Country	:	US
Telephone Number	:	609-442-1667
Fax Number	:

Provider Business Practice Location Address
First Line	:	6307 VENTNOR AVE
Second Line	:
City	:	VENTNOR
State	:	NJ
Zip	:	08406-2273
Country	:	US
Telephone Number	:	609-822-2628
Fax Number	:	609-822-5173

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

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	07/08/2007

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