MEDICARE: WENDY ALICE PERLMUTTER 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	2251P0200X	Pediatric Physical Therapist	PT012525L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	101123975 0002	OTHER	PA	MA PROMISE NUMBER

General Provider Information

NPI Number	:	1417173196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY ALICE PERLMUTTER PT

Provider Business Mailing Address
First Line	:	3508 N SUGAN RD
Second Line	:
City	:	NEW HOPE
State	:	PA
Zip	:	18938-9671
Country	:	US
Telephone Number	:	215-297-0624
Fax Number	:

Provider Business Practice Location Address
First Line	:	3508 N SUGAN RD
Second Line	:
City	:	NEW HOPE
State	:	PA
Zip	:	18938-9671
Country	:	US
Telephone Number	:	215-297-0624
Fax Number	:

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

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	07/08/2007

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