MEDICARE: A JOINT VENTURE PHYSICAL THERAPY, L.L.C.

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

General Provider Information

NPI Number	:	1437384492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A JOINT VENTURE PHYSICAL THERAPY, L.L.C.

Provider Business Mailing Address
First Line	:	9613 BERRYVILLE CT
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27617-7607
Country	:	US
Telephone Number	:	919-616-4487
Fax Number	:	919-233-6781

Provider Business Practice Location Address
First Line	:	3509 HAWORTH DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-7238
Country	:	US
Telephone Number	:	919-616-4487
Fax Number	:	919-233-6781

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. VIVIAN KWEE MAST
Credential	:	MPT
Telephone Number	:	919-616-4487

Provider Enumeration Date	:	05/20/2009
Last Update Date	:	05/20/2009

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