Healthcare Provider Details

I. General information

NPI: 1285309559
Provider Name (Legal Business Name): PARIS AGNEW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 GREENE ST
PHILADELPHIA PA
19119-3231
US

IV. Provider business mailing address

82 PEACH ST
WESTVILLE NJ
08093-2113
US

V. Phone/Fax

Practice location:
  • Phone: 215-844-6400
  • Fax:
Mailing address:
  • Phone: 856-418-4883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTEI004952
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: