MEDICARE: MONICA MCNICHOL

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	2251X0800X	Orthopedic Physical Therapist	PT027238	PA

General Provider Information

NPI Number	:	1710467808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA MCNICHOL

Provider Business Mailing Address
First Line	:	475 ALLENDALE RD STE 206
Second Line	:
City	:	KING OF PRUSSIA
State	:	PA
Zip	:	19406-1495
Country	:	US
Telephone Number	:	610-270-0370
Fax Number	:	610-270-0374

Provider Business Practice Location Address
First Line	:	3331 STREET RD
Second Line	:
City	:	BENSALEM
State	:	PA
Zip	:	19020-2052
Country	:	US
Telephone Number	:	215-639-1600
Fax Number	:	215-639-8216

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

Provider Enumeration Date	:	08/17/2018
Last Update Date	:	11/18/2019

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