Healthcare Provider Details

I. General information

NPI: 1003882580
Provider Name (Legal Business Name): ERIN M DONNELLY PHYSICAL THERAPY ASS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 E MAPLE AVE FL 2
LANGHORNE PA
19047-2186
US

IV. Provider business mailing address

133 E MAPLE AVE FL 2
LANGHORNE PA
19047-2186
US

V. Phone/Fax

Practice location:
  • Phone: 267-982-3623
  • Fax:
Mailing address:
  • Phone: 267-982-3623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE012511
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT003487
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: