Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT025865 | PA |
NPI | 1013457175 |
---|---|
Provider Name | Eric Ciabattoni |
First Address | Berwyn, PA 19312-1297 |
Second Address | Berwyn, PA 19312-1297 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2017 |
Last Update Date | 08/03/2017 |