Healthcare Provider Details

I. General information

NPI: 1598988099
Provider Name (Legal Business Name): DEXTER KIERULF SINGZON LPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 ELDON AVE
LANSDOWNE PA
19050-1815
US

IV. Provider business mailing address

36 ELDON AVE
LANSDOWNE PA
19050-1815
US

V. Phone/Fax

Practice location:
  • Phone: 610-259-9603
  • Fax: 610-259-9619
Mailing address:
  • Phone: 610-259-9603
  • Fax: 610-259-9619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPT008846L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: