Provider Demographics
NPI:1376585463
Name:PELLICONE, AMIE (DPT)
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:
Last Name:PELLICONE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 FOX CHASE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:PA
Mailing Address - Zip Code:19046-4437
Mailing Address - Country:US
Mailing Address - Phone:215-663-8050
Mailing Address - Fax:215-663-9388
Practice Address - Street 1:888 FOX CHASE RD
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:PA
Practice Address - Zip Code:19046-4437
Practice Address - Country:US
Practice Address - Phone:215-663-8050
Practice Address - Fax:215-663-9388
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016444225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist