MEDICARE: MATTHEW THOMAS PARKER PHYSICAL THERAPIST

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	40QA01579100	NJ

General Provider Information

NPI Number	:	1396723680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW THOMAS PARKER PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	84 W SHORE TRL
Second Line	:
City	:	SPARTA
State	:	NJ
Zip	:	07871-1746
Country	:	US
Telephone Number	:	973-512-3472
Fax Number	:

Provider Business Practice Location Address
First Line	:	376 LAFAYETTE RD STE 105
Second Line	:
City	:	SPARTA
State	:	NJ
Zip	:	07871-3560
Country	:	US
Telephone Number	:	973-579-3027
Fax Number	:

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

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	01/21/2015

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