Healthcare Provider Details

I. General information

NPI: 1952425894
Provider Name (Legal Business Name): DVORAH KEREN LICHTENSTEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 STRATFORD DR
CHURCHVILLE PA
18966-1344
US

IV. Provider business mailing address

176 STRATFORD DR
CHURCHVILLE PA
18966-1344
US

V. Phone/Fax

Practice location:
  • Phone: 215-357-1662
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3801L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: