Healthcare Provider Details

I. General information

NPI: 1639101769
Provider Name (Legal Business Name): WILLIAM M DEUBER JR. PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 HAVERFORD RD 1ST FLOOR
BRYN MAWR PA
19010-3814
US

IV. Provider business mailing address

945 HAVERFORD RD 1ST FLOOR
BRYN MAWR PA
19010-3814
US

V. Phone/Fax

Practice location:
  • Phone: 610-525-1223
  • Fax: 610-525-5797
Mailing address:
  • Phone: 610-525-1223
  • Fax: 610-525-5797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT003474L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: