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NPI Code Detail

MEDICARE: PATRICIA ROSE CHADDERDON PTA COTA/L

MEDICARE: PATRICIA ROSE CHADDERDON PTA COTA/L
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
1208100000XPhysical Medicine & Rehabilitation PhysicianOP005794PA
2208100000XPhysical Medicine & Rehabilitation PhysicianTE1002554PA

General Provider Information

NPI Number : 1306352430
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICIA ROSE CHADDERDON PTA COTA/L
Provider Business Mailing Address
First Line : 8206 PLEASANT VALLEY RD
Second Line :
City : COGAN STATION
State : PA
Zip : 17728-8522
Country : US
Telephone Number : 570-971-3332
Fax Number :
Provider Business Practice Location Address
First Line : 2140 WARRENSVILLE RD
Second Line :
City : MONTOURSVILLE
State : PA
Zip : 17754-9621
Country : US
Telephone Number : 570-433-3161
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2017
Last Update Date : 12/27/2017

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