Provider Demographics
NPI:1285206805
Name:CANTWELL, TERRENCE PAUL JR (DPT)
Entity Type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:PAUL
Last Name:CANTWELL
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:712 AUTUMN RIVER RUN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-4359
Mailing Address - Country:US
Mailing Address - Phone:973-464-2288
Mailing Address - Fax:
Practice Address - Street 1:4700 WISSAHICKON AVE STE 120
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-4248
Practice Address - Country:US
Practice Address - Phone:215-991-3982
Practice Address - Fax:215-991-3983
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT029510225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist