MEDICARE: GERALDINE BATTUNG POBLETE LPT

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	2251X0800X	Orthopedic Physical Therapist	PT011328L	PA

General Provider Information

NPI Number	:	1477671071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALDINE BATTUNG POBLETE LPT

Provider Business Mailing Address
First Line	:	303 LONG MEADOW DRIVE
Second Line	:
City	:	MULLICA HILL
State	:	NJ
Zip	:	08062
Country	:	US
Telephone Number	:	856-478-6723
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 BILLOWS DRIVE
Second Line	:
City	:	MOUNT ROYAL
State	:	NJ
Zip	:	08061
Country	:	US
Telephone Number	:	856-478-6723
Fax Number	:

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	11/04/2016

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