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NPI Code Detail

MEDICARE: RONETH FAJARDO R.P.T.

MEDICARE: RONETH FAJARDO R.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
12251G0304XGeriatric Physical TherapistPT020320PA
22251G0304XGeriatric Physical Therapist029125NY

General Provider Information

NPI Number : 1710262852
Entity Type Code : Individual
Provider Name (Legal Business Name) : RONETH FAJARDO R.P.T.
Provider Business Mailing Address
First Line : 139 FULTON ST
Second Line : SUITE 502
City : NEW YORK
State : NY
Zip : 10038-2594
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6445 GERMANTOWN AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19119-2345
Country : US
Telephone Number : 215-438-5268
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2011
Last Update Date : 10/20/2011

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