MEDICARE: KRISTEN PEZZILLO MSPT, CWS

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	PT012813L	PA

General Provider Information

NPI Number	:	1609659549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN PEZZILLO MSPT, CWS

Provider Business Mailing Address
First Line	:	1180 LAURELWOOD RD
Second Line	:
City	:	POTTSTOWN
State	:	PA
Zip	:	19465-7422
Country	:	US
Telephone Number	:	610-850-1725
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 S JUNIPER ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-2703
Country	:	US
Telephone Number	:	732-994-3200
Fax Number	:

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

Provider Enumeration Date	:	08/15/2023
Last Update Date	:	08/15/2023

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