MEDICARE: MIRIAM DEFAY 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	PT007286L	PA

General Provider Information

NPI Number	:	1750564951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRIAM DEFAY PT

Provider Business Mailing Address
First Line	:	5 CEDAR HEIGHTS EST
Second Line	:
City	:	DUNCANSVILLE
State	:	PA
Zip	:	16635-1459
Country	:	US
Telephone Number	:	814-693-9243
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 CEDAR HEIGHTS EST
Second Line	:
City	:	DUNCANSVILLE
State	:	PA
Zip	:	16635-1459
Country	:	US
Telephone Number	:	814-693-9243
Fax Number	:

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

Provider Enumeration Date	:	12/11/2007
Last Update Date	:	12/11/2007

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Directions to “ MIRIAM DEFAY PT” Practice Location

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