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NPI Code Detail

MEDICARE: MARY L DENARDO PTA

MEDICARE: MARY L DENARDO PTA
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
1225200000XPhysical Therapy AssistantQB0000671NJ

General Provider Information

NPI Number : 1467679340
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY L DENARDO PTA
Provider Business Mailing Address
First Line : 5501 HALE AVE
Second Line :
City : BETHLEHEM
State : PA
Zip : 18017-9036
Country : US
Telephone Number : 610-868-1674
Fax Number :
Provider Business Practice Location Address
First Line : 390 RED SCHOOL LN
Second Line :
City : PHILLIPSBURG
State : NJ
Zip : 08865-2230
Country : US
Telephone Number : 908-859-0200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2007
Last Update Date : 07/08/2007

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