1295385425 NPI number — LAURIE KAY BOROWSKI SEYDEL PTA, CLWT, GTS

Table of content: SARA MARIETTA NP (NPI 1235500646)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295385425 NPI number — LAURIE KAY BOROWSKI SEYDEL PTA, CLWT, GTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEYDEL
Provider First Name:
LAURIE KAY
Provider Middle Name:
BOROWSKI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PTA, CLWT, GTS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295385425
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
133 ORCHARD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIXVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19460-2022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-246-7162
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1615 E BOOT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST CHESTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19380-6001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-653-4400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/19/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225200000X , with the licence number:  TE010602 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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