=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356462162
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CIARA LYNN PREZUHY PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3975 CONSHOHOCKEN AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19131-5426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-879-1000
-----------------------------------------------------
Fax | 215-879-3912
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3398 PIN OAK LN
-----------------------------------------------------
City | CHALFONT
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18914-3455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-491-2903
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT005196L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------