MEDICARE: JUDITH BONITA OLIVER P.T.A.

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	225200000X	Physical Therapy Assistant	TEL000091	PA

General Provider Information

NPI Number	:	1881808855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH BONITA OLIVER P.T.A.

Provider Business Mailing Address
First Line	:	6137 MORTON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-1002
Country	:	US
Telephone Number	:	215-843-6350
Fax Number	:

Provider Business Practice Location Address
First Line	:	6137 MORTON STREET
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-1002
Country	:	US
Telephone Number	:	215-843-6350
Fax Number	:

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

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	05/01/2012

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