Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT024521 | PA |
NPI | 1003283011 |
---|---|
Provider Name | Miss Katie Angelucci |
First Address | Plymouth Meeting, PA 19462-1420 |
Second Address | Royersford, PA 19468-3807 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2015 |
Last Update Date | 25/08/2015 |