MEDICARE: MICHAEL BRONDUM P.T.

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	PT016270	PA

General Provider Information

NPI Number	:	1659395135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL BRONDUM P.T.

Provider Business Mailing Address
First Line	:	8104 PATRICIA DR
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15237-6330
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 E NEW CASTLE ST
Second Line	:
City	:	ZELIENOPLE
State	:	PA
Zip	:	16063-1333
Country	:	US
Telephone Number	:	724-452-8360
Fax Number	:	724-452-2253

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	07/08/2007

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