MEDICARE: BRIAN WALPOLE 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	PT022228	PA
2	225100000X	Physical Therapist	40QA00933700	NJ

General Provider Information

NPI Number	:	1790025567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN WALPOLE MPT

Provider Business Mailing Address
First Line	:	251 BURRWOOD AVE
Second Line	:
City	:	HADDON TWP
State	:	NJ
Zip	:	08108-1724
Country	:	US
Telephone Number	:	856-854-1838
Fax Number	:

Provider Business Practice Location Address
First Line	:	251 BURRWOOD AVE
Second Line	:
City	:	HADDON TWP
State	:	NJ
Zip	:	08108-1724
Country	:	US
Telephone Number	:	856-854-1838
Fax Number	:

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

Provider Enumeration Date	:	02/15/2013
Last Update Date	:	02/15/2013

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