MEDICARE: JOINT & SPINE PHYSICAL THERAPY, LLC

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	PT012940L	PA

General Provider Information

NPI Number	:	1477584498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOINT & SPINE PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	4647 W CHESTER PIKE
Second Line	:
City	:	NEWTOWN SQUARE
State	:	PA
Zip	:	19073-2226
Country	:	US
Telephone Number	:	610-353-7533
Fax Number	:	610-353-7535

Provider Business Practice Location Address
First Line	:	4647 W CHESTER PIKE
Second Line	:
City	:	NEWTOWN SQUARE
State	:	PA
Zip	:	19073-2226
Country	:	US
Telephone Number	:	610-353-7533
Fax Number	:	610-353-7535

Authorized Official
Title or Position	:	OWNER/PHYSICAL THERAPIST
Name	:	MARTIN A. ZACKROFF
Credential	:	MPT
Telephone Number	:	610-353-7533

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	10/30/2007

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