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General NPI Number Information
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NPI Number | 1588280333
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Entity Type | Individual
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Provider Name | MARY CALLERY PTA
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Gender | Female
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Dates
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Enumeration Date | 06/17/2020
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Last Update Date | 06/17/2020
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Provider Practice Location Address
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Address Line | 16 INDUSTRIAL BLVD. STE. 101
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City | PAOLI
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State | PA
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Zip | 19301
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Country | US
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Telephone |
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Fax |
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Provider Business Mailing Address
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Address Line | 350 HUNTINGTON CT
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City | WEST CHESTER
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State | PA
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Zip | 19380-1780
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Country | US
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Telephone |
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Fax |
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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 | TE005285L
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License Number State | PA
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