MEDICARE: MISS EILEEN MONIQUE DAILEY 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
1	225200000X	Physical Therapy Assistant	TE011099	PA

General Provider Information

NPI Number	:	1417493651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS EILEEN MONIQUE DAILEY PTA

Provider Business Mailing Address
First Line	:	517 WEDGE DR
Second Line	:
City	:	DICKSON CITY
State	:	PA
Zip	:	18519-1587
Country	:	US
Telephone Number	:	215-870-8123
Fax Number	:

Provider Business Practice Location Address
First Line	:	517 WEDGE DR
Second Line	:
City	:	DICKSON CITY
State	:	PA
Zip	:	18519-1587
Country	:	US
Telephone Number	:	215-870-8123
Fax Number	:

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

Provider Enumeration Date	:	01/11/2017
Last Update Date	:	01/11/2017

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