MEDICARE: PEN PHYSICAL THERAPY & REHAB SERVICES, P.C.

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	174400000X	Specialist

General Provider Information

NPI Number	:	1952515058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEN PHYSICAL THERAPY & REHAB SERVICES, P.C.

Provider Business Mailing Address
First Line	:	1450 PARKSIDE AVE
Second Line	:	SUITE 26
City	:	EWING
State	:	NJ
Zip	:	08638-2946
Country	:	US
Telephone Number	:	609-406-9363
Fax Number	:

Provider Business Practice Location Address
First Line	:	1450 PARKSIDE AVE
Second Line	:	SUITE 26
City	:	EWING
State	:	NJ
Zip	:	08638-2946
Country	:	US
Telephone Number	:	609-406-9363
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	COMFORT OGBONNA
Credential	:
Telephone Number	:	609-406-9363

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	11/12/2009

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