Provider Demographics
NPI:1124046578
Name:DOOLEY, BRENDA (PT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:DOOLEY
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 1:2 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MARCUS HOOK
Mailing Address - State:PA
Mailing Address - Zip Code:19061-4513
Mailing Address - Country:US
Mailing Address - Phone:610-859-8850
Mailing Address - Fax:610-859-7876
Practice Address - Street 1:1331 E WYOMING AVE
Practice Address - Street 2:SUITE 4120
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-3808
Practice Address - Country:US
Practice Address - Phone:215-831-1170
Practice Address - Fax:215-744-7394
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT009983225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30068870OtherKEYSTONE MERCY
306142OtherUNISON
PA68640OtherHIGHMARK PABS
PA50065703OtherCAPITAL BLUE CROSS
PA001697605-0008Medicaid
PA0247464000OtherIBC
PA50065703OtherCAPITAL BLUE CROSS