Provider Demographics
NPI:1265649263
Name:FLANAGAN, LEA (MSPT)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 E CITY AVE
Mailing Address - Street 2:STE 250
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1730
Mailing Address - Country:US
Mailing Address - Phone:610-668-4055
Mailing Address - Fax:610-668-4250
Practice Address - Street 1:720 YORKLYN RD
Practice Address - Street 2:SUITE 150
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-8728
Practice Address - Country:US
Practice Address - Phone:302-234-2288
Practice Address - Fax:302-234-2869
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT014018L225100000X
DEJ1-00001567225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
G02691P01Medicare PIN