MEDICARE: JEREMY T KUSHNER 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	PT-022016	PA

General Provider Information

NPI Number	:	1699030254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY T KUSHNER MPT

Provider Business Mailing Address
First Line	:	6651 SILVER CREST RD
Second Line	:
City	:	BATH
State	:	PA
Zip	:	18014-8906
Country	:	US
Telephone Number	:	484-526-7355
Fax Number	:	484-526-7356

Provider Business Practice Location Address
First Line	:	6651 SILVER CREST RD
Second Line	:
City	:	BATH
State	:	PA
Zip	:	18014-8906
Country	:	US
Telephone Number	:	484-526-7355
Fax Number	:	484-526-7356

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

Provider Enumeration Date	:	07/10/2012
Last Update Date	:	08/26/2016

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