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General NPI Number Information
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NPI Number | 1912493768
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Entity Type | Individual
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Provider Name | EMMA PERRY CADWALLADER RPT
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Gender | Female
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Dates
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Enumeration Date | 07/05/2018
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 862 MEINECKE AVE STE 101
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93405-3702
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Country | US
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Telephone | 805-619-0414
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Fax | 805-549-5253
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Provider Business Mailing Address
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Address Line | 79 DURLAND AVE
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City | ELMIRA
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State | NY
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Zip | 14905-1938
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Country | US
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Telephone | 607-731-4405
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 24050
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTH8932
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT305645
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License Number State | CA
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