MEDICARE: MR. JOSEPH WILLIAM GRUGAN 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
1	174400000X	Specialist	TE005643L	PA

General Provider Information

NPI Number	:	1538160288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH WILLIAM GRUGAN PTA

Provider Business Mailing Address
First Line	:	209 AMOSLAND RD
Second Line	:
City	:	HOLMES
State	:	PA
Zip	:	19043-1401
Country	:	US
Telephone Number	:	610-534-1246
Fax Number	:	215-676-3746

Provider Business Practice Location Address
First Line	:	9379 KREWSTOWN RD
Second Line	:	EXCEL PHYSICAL THERAPY
City	:	PHILA
State	:	PA
Zip	:	19115-3710
Country	:	US
Telephone Number	:	215-676-6760
Fax Number	:	215-676-3746

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

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	07/08/2007

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