MEDICARE: JACQUELYN DITTMEIER DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT028321	PA

General Provider Information

NPI Number	:	1134751910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELYN DITTMEIER DPT

Provider Business Mailing Address
First Line	:	10980 NORCOM RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19154-2302
Country	:	US
Telephone Number	:	215-677-1149
Fax Number	:	215-677-1169

Provider Business Practice Location Address
First Line	:	10980 NORCOM RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19154-2302
Country	:	US
Telephone Number	:	215-677-1149
Fax Number	:	215-677-1169

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2020
Last Update Date	:	07/31/2023

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