Healthcare Provider Details

I. General information

NPI: 1952839425
Provider Name (Legal Business Name): CAROLYN MARIE DAMIANO PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 N VALLEY FORGE RD
DEVON PA
19333-1239
US

IV. Provider business mailing address

1328 KATHERINE LN
WEST CHESTER PA
19380-6208
US

V. Phone/Fax

Practice location:
  • Phone: 610-263-2300
  • Fax:
Mailing address:
  • Phone: 484-553-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTEI004091
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: