Healthcare Provider Details

I. General information

NPI: 1982960779
Provider Name (Legal Business Name): DAVID JAMES VERZELLA P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 W TOWNSHIP LINE RD STE 110
HAVERTOWN PA
19083-4930
US

IV. Provider business mailing address

1311 MAMARONECK AVE STE 140
WHITE PLAINS NY
10605-5224
US

V. Phone/Fax

Practice location:
  • Phone: 267-281-5253
  • Fax: 267-281-5253
Mailing address:
  • Phone: 914-294-4050
  • Fax: 631-760-8306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT021396
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: