Provider Demographics
NPI:1285684134
Name:DETWEILER, JOHN (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:DETWEILER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-2820
Mailing Address - Country:US
Mailing Address - Phone:215-822-7785
Mailing Address - Fax:
Practice Address - Street 1:LIFE MARK DR
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960
Practice Address - Country:US
Practice Address - Phone:215-257-8668
Practice Address - Fax:215-257-0510
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT002894L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA410856OtherHIGHMARK
PAPC410856OtherPERSONAL CHOICE
PAKHPEO133709000OtherKEYSTONE HEALTH PLAN EAST