Provider Demographics
NPI:1386650240
Name:DENTREMONT, ELIZABETH (LPT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:DENTREMONT
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 LANCANTER AVE
Mailing Address - Street 2:#225
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301
Mailing Address - Country:US
Mailing Address - Phone:610-651-8282
Mailing Address - Fax:610-651-8283
Practice Address - Street 1:250 LANCANTER AVE
Practice Address - Street 2:#225
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301
Practice Address - Country:US
Practice Address - Phone:610-651-8282
Practice Address - Fax:610-651-8283
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
2284912000OtherPERSONAL CHOICE 65
1606882OtherBLUE CROSS BLUE SHIELD
078015QZYMedicare ID - Type Unspecified
2284912000OtherPERSONAL CHOICE 65