Provider Demographics
NPI:1114160942
Name:VERSCHELDE, JOSEPH WILLIAM (PT A)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:WILLIAM
Last Name:VERSCHELDE
Suffix:
Gender:M
Credentials:PT A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2990 HOLME AVE
Mailing Address - Street 2:IMMACULATE MARY HOME
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19136
Mailing Address - Country:US
Mailing Address - Phone:215-992-1861
Mailing Address - Fax:215-335-1335
Practice Address - Street 1:2990 HOLME AVE
Practice Address - Street 2:IMMACULATE MARY HOME
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-1830
Practice Address - Country:US
Practice Address - Phone:215-992-1861
Practice Address - Fax:215-335-1335
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI000691225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant