MEDICARE: MR. PETER MICHAEL MOHACEY MPT

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	PT007797L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2112462000	OTHER	PA	KEYSTONE HEALTHPLAN EAST
2	1426092	OTHER	PA	IBC
3	3104173	OTHER	PA	AETNA

General Provider Information

NPI Number	:	1689678369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PETER MICHAEL MOHACEY MPT

Provider Business Mailing Address
First Line	:	1111 HAGUES MILL RD
Second Line	:
City	:	AMBLER
State	:	PA
Zip	:	19002-6000
Country	:	US
Telephone Number	:	215-646-2025
Fax Number	:

Provider Business Practice Location Address
First Line	:	270 COMMERCE DR
Second Line	:	STE 190
City	:	FT WASHINGTON
State	:	PA
Zip	:	19034-2405
Country	:	US
Telephone Number	:	215-654-1520
Fax Number	:	215-654-1529

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/08/2007

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