Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT026087 | PA |
NPI | 1407379951 |
---|---|
Provider Name | Gemma Longfellow |
First Address | Drexel Hill, PA 19026-1803 |
Second Address | Abington, PA 19001-4622 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2017 |
Last Update Date | 17/07/2017 |