Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT007925L | PA |
NPI | 1003284910 |
---|---|
Provider Name | Lisa Gualtieri |
First Address | Glenmoore, PA 19343-1140 |
Second Address | East Fallowfield Township, PA 19320-2874 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2015 |
Last Update Date | 09/09/2015 |