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General NPI Number Information
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NPI Number | 1356574834
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Entity Type | Individual
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Provider Name | ELLEN JUDITH DETWEILER P.T.
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Gender | Female
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Dates
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Enumeration Date | 08/31/2009
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Last Update Date | 09/22/2009
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Provider Practice Location Address
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Address Line | 1101 E. 3RD ST.
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-5411
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Country | US
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Telephone | 570-322-5500
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Fax | 570-322-8100
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Provider Business Mailing Address
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Address Line | 1101 E. 3RD ST.
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-5411
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Country | US
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Telephone | 570-322-5500
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Fax | 570-322-8100
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT010898L
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License Number State | PA
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