Basic Information
| Provider Information | |||||||||
| NPI: | 1548661846 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ANNAND | ||||||||
| FirstName: | CAROL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 412 FIRST AVE | ||||||||
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| City: | NEWTOWN SQUARE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190734509 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 105 MORTON AVE | ||||||||
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| City: | RIDLEY PARK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190782409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105211331 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2014 | ||||||||
| LastUpdateDate: | 09/06/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | TE000112L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.