Registry details
Type
Individual
Primary specialty
Physical Therapist
Enumerated
May 15, 2007
License(s)
PT005876L (PA), DAPToooo68 (PA), J1-0001113 (DE)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 433 HERMITAGE ST | Philadelphia, PA 19128-3330 | 215-432-1065 |
| LOCATION | 1065 ANDREW DR STE B-3 | West Chester, PA 19380-4293 | 610-344-7374 |
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