MEDICARE: DENITA NEWSOME

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	PT007317L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001935322001	OTHER	PA	MA

General Provider Information

NPI Number	:	1639394380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENITA NEWSOME

Provider Business Mailing Address
First Line	:	7247 LINDBERGH BLVD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19153-2705
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7247 LINDBERGH BLVD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19153-2705
Country	:	US
Telephone Number	:	610-764-0486
Fax Number	:

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

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	06/27/2019

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Directions to “ DENITA NEWSOME ” Practice Location

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