Provider Demographics
NPI:1073062519
Name:RADICH, STASIA WHALEN (PT)
Entity Type:Individual
Prefix:
First Name:STASIA
Middle Name:WHALEN
Last Name:RADICH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:STASIA
Other - Middle Name:ANN
Other - Last Name:WHALEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:795 E MARSHALL ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4400
Mailing Address - Country:US
Mailing Address - Phone:610-696-6511
Mailing Address - Fax:610-429-2470
Practice Address - Street 1:795 E MARSHALL ST
Practice Address - Street 2:SUITE 204
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4400
Practice Address - Country:US
Practice Address - Phone:610-696-6511
Practice Address - Fax:610-429-2470
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005159Z225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist