Provider Demographics
NPI:1376794057
Name:RECTO, ROSALIE T (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ROSALIE
Middle Name:T
Last Name:RECTO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ROSALIE
Other - Middle Name:T
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:100 E LANCASTER AVE
Mailing Address - Street 2:DEPT OF SURGERY, SUITE #422
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:484-476-2000
Mailing Address - Fax:
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:DEPT OF SURGERY, SUITE #422
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:484-476-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003236L363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical