MEDICARE: JOHN AHERN 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	032587-1	NY

General Provider Information

NPI Number	:	1700102282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN AHERN PT

Provider Business Mailing Address
First Line	:	807 RIDGE RD STE B
Second Line	:
City	:	WEBSTER
State	:	NY
Zip	:	14580-2497
Country	:	US
Telephone Number	:	585-347-0202
Fax Number	:	585-347-0203

Provider Business Practice Location Address
First Line	:	807 RIDGE RD STE B
Second Line	:
City	:	WEBSTER
State	:	NY
Zip	:	14580-2497
Country	:	US
Telephone Number	:	585-347-0202
Fax Number	:	585-347-0203

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

Provider Enumeration Date	:	04/09/2010
Last Update Date	:	04/09/2010

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Directions to “ JOHN AHERN PT” Practice Location

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