1821697442 NPI number — HEATHER SPADOLA PT, DPT

Table of content: HEATHER SPADOLA PT, DPT (NPI 1821697442)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821697442 NPI number — HEATHER SPADOLA PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPADOLA
Provider First Name:
HEATHER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
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:
1821697442
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 45926
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21297-5926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-642-8837
Provider Business Mailing Address Fax Number:
610-642-1607

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2895 HAMILTON BLVD
Provider Second Line Business Practice Location Address:
STE102
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18104-6172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-330-9740
Provider Business Practice Location Address Fax Number:
610-432-4887
Provider Enumeration Date:
10/24/2020

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: 208100000X , with the licence number:  PT028772 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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