MEDICARE: BRIAN P KANE 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	225200000X	Physical Therapy Assistant	TEI000728	PA

General Provider Information

NPI Number	:	1578092219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN P KANE PTA

Provider Business Mailing Address
First Line	:	2217 MARTHA ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-2025
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 GRANT AVE STE 20
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-2632
Country	:	US
Telephone Number	:	215-647-9601
Fax Number	:

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

Provider Enumeration Date	:	06/07/2017
Last Update Date	:	06/07/2017

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Directions to “ BRIAN P KANE PTA” Practice Location

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