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General NPI Number Information
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NPI Number | 1891753471
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Entity Type | Individual
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Provider Name | CARRIE ANNE DEPERRO MPT
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Gender | Female
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 07/15/2022
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Provider Practice Location Address
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Address Line | 790 PENLLYN BLUE BELL PIKE STE 101
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City | BLUE BELL
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State | PA
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Zip | 19422-1657
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Country | US
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Telephone | 267-458-4998
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Fax | 267-419-8761
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Provider Business Mailing Address
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Address Line | 224 STRAWBRIDGE DR STE 100
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City | MOORESTOWN
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State | NJ
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Zip | 08057-4602
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Country | US
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Telephone | 856-677-4000
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Fax | 856-234-3014
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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 | PT015398
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License Number State | PA
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