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NPI Code Detail

MEDICARE: GRACE KELLY PTA

MEDICARE: GRACE KELLY PTA
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
1225200000XPhysical Therapy AssistantTE000562LPA

General Provider Information

NPI Number : 1326375171
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE KELLY PTA
Provider Business Mailing Address
First Line : 629 N WALES RD
Second Line :
City : NORTH WALES
State : PA
Zip : 19454-1724
Country : US
Telephone Number : 215-630-1788
Fax Number :
Provider Business Practice Location Address
First Line : 850 PAPER MILL RD
Second Line :
City : GLENSIDE
State : PA
Zip : 19038-7833
Country : US
Telephone Number : 215-233-0920
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2009
Last Update Date : 11/14/2009

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Directions to “ GRACE KELLY PTA” Practice Location

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