Provider Demographics
NPI:1235732587
Name:MACH, JACQUELINE AVILA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:AVILA
Last Name:MACH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3809 W CHESTER PIKE STE 150
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-0259
Mailing Address - Country:US
Mailing Address - Phone:610-359-5640
Mailing Address - Fax:610-359-1519
Practice Address - Street 1:300 SPRINGHOUSE DR STE 201
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-4021
Practice Address - Country:US
Practice Address - Phone:610-489-4745
Practice Address - Fax:610-489-4209
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT029048225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist