Healthcare Provider Details

I. General information

NPI: 1104816313
Provider Name (Legal Business Name): AMY MARIE DALESSANDRO M.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 E HAVERFORD RD
BRYN MAWR PA
19010-3838
US

IV. Provider business mailing address

931 E HAVERFORD RD
BRYN MAWR PA
19010-3838
US

V. Phone/Fax

Practice location:
  • Phone: 610-527-7870
  • Fax: 610-527-2337
Mailing address:
  • Phone: 610-527-7870
  • Fax: 610-527-2337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT009672L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: