Provider Demographics
NPI:1174833487
Name:PITONYAK, LOUIS J JR (OT)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:J
Last Name:PITONYAK
Suffix:JR
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 DEKALB PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-3367
Mailing Address - Country:US
Mailing Address - Phone:610-277-1990
Mailing Address - Fax:610-277-2007
Practice Address - Street 1:1515 DEKALB PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-3367
Practice Address - Country:US
Practice Address - Phone:610-277-1990
Practice Address - Fax:610-277-2007
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC006285L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist