MEDICARE: MRS. EDITA KOTES MS, PT

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	2251P0200X	Pediatric Physical Therapist

General Provider Information

NPI Number	:	1992867022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EDITA KOTES MS, PT

Provider Business Mailing Address
First Line	:	4539 US HIGHWAY 9
Second Line	:
City	:	HOWELL
State	:	NJ
Zip	:	07731-3380
Country	:	US
Telephone Number	:	732-901-5553
Fax Number	:	732-901-1131

Provider Business Practice Location Address
First Line	:	4539 US HIGHWAY 9
Second Line	:
City	:	HOWELL
State	:	NJ
Zip	:	07731-3380
Country	:	US
Telephone Number	:	732-901-5553
Fax Number	:	732-901-1131

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	07/08/2007

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