MEDICARE: BAY-SEA PHYSICAL THERAPY OF BRIDGETON PA

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	56001	OTHER		CIGNA

General Provider Information

NPI Number	:	1568468072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY-SEA PHYSICAL THERAPY OF BRIDGETON PA

Provider Business Mailing Address
First Line	:	232 LAUREL HEIGHTS DR
Second Line	:	BLDG 4
City	:	BRIDGETON
State	:	NJ
Zip	:	08302-3634
Country	:	US
Telephone Number	:	856-455-9730
Fax Number	:	855-455-5165

Provider Business Practice Location Address
First Line	:	232 LAUREL HEIGHTS DR
Second Line	:	BLDG 4
City	:	BRIDGETON
State	:	NJ
Zip	:	08302-3634
Country	:	US
Telephone Number	:	856-455-9730
Fax Number	:	855-455-5165

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	DONNA BUSCEMI
Credential	:
Telephone Number	:	856-455-9730

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	07/10/2008

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