Provider Demographics
NPI:1114178621
Name:BANERJEE, LOPAMUDRA (PT)
Entity Type:Individual
Prefix:
First Name:LOPAMUDRA
Middle Name:
Last Name:BANERJEE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 SCARBORO DRIVE
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3818
Mailing Address - Country:US
Mailing Address - Phone:717-843-4957
Mailing Address - Fax:
Practice Address - Street 1:108 SCARBORO DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3818
Practice Address - Country:US
Practice Address - Phone:717-843-4957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18047225100000X
PAPT008732E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist