MEDICARE: BRIAN DAVID JERVA DPT

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	PT017563	PA

General Provider Information

NPI Number	:	1851399950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN DAVID JERVA DPT

Provider Business Mailing Address
First Line	:	730 S BROAD ST
Second Line	:
City	:	LANSDALE
State	:	PA
Zip	:	19446-5211
Country	:	US
Telephone Number	:	267-663-7767
Fax Number	:	215-855-8748

Provider Business Practice Location Address
First Line	:	3537 W CHESTER PIKE
Second Line	:
City	:	NEWTOWN SQUARE
State	:	PA
Zip	:	19073-3701
Country	:	US
Telephone Number	:	610-723-7771
Fax Number	:	610-723-7772

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	12/26/2019

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