MEDICARE: DR. GARY STEVEN STRUBLE PT

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	40QA00899200	NJ
2	2251X0800X	Orthopedic Physical Therapist	40QA00899200	NJ

General Provider Information

NPI Number	:	1619061710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY STEVEN STRUBLE PT

Provider Business Mailing Address
First Line	:	35 TILLEY AVE
Second Line	:
City	:	POMPTON PLAINS
State	:	NJ
Zip	:	07444-1901
Country	:	US
Telephone Number	:	973-248-6890
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 HAMBURG TPKE
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-8480
Country	:	US
Telephone Number	:	973-706-7620
Fax Number	:

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	08/11/2014

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