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General NPI Number Information
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NPI Number | 1114160942
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Entity Type | Individual
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Provider Name | JOSEPH WILLIAM VERSCHELDE P.T. A.
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Gender | Male
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Dates
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Enumeration Date | 04/09/2009
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Last Update Date | 04/09/2009
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Provider Practice Location Address
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Address Line | 2990 HOLME AVE IMMACULATE MARY HOME
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City | PHILADELPHIA
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State | PA
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Zip | 19136-1830
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Country | US
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Telephone | 215-992-1861
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Fax | 215-335-1335
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Provider Business Mailing Address
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Address Line | 2990 HOLME AVE IMMACULATE MARY HOME
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City | PHILADELPHIA
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State | PA
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Zip | 19136
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Country | US
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Telephone | 215-992-1861
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Fax | 215-335-1335
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | TEI000691
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License Number State | PA
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