MEDICARE: REGINA ROSENTHAL 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
1	225100000X	Physical Therapist	QA02977	NJ

General Provider Information

NPI Number	:	1831308097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINA ROSENTHAL P.T.

Provider Business Mailing Address
First Line	:	PO BOX 344
Second Line	:
City	:	MIDDLETOWN
State	:	NJ
Zip	:	07748-0344
Country	:	US
Telephone Number	:	732-706-5216
Fax Number	:	732-706-5217

Provider Business Practice Location Address
First Line	:	71 LAGUNA HILLS CT
Second Line	:
City	:	HOLMDEL
State	:	NJ
Zip	:	07733-2554
Country	:	US
Telephone Number	:	732-706-5216
Fax Number	:	732-706-5217

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/08/2007

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