Provider Demographics
NPI:1407379951
Name:LONGFELLOW, GEMMA
Entity Type:Individual
Prefix:
First Name:GEMMA
Middle Name:
Last Name:LONGFELLOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 COBBS ST
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-1803
Mailing Address - Country:US
Mailing Address - Phone:757-617-7659
Mailing Address - Fax:
Practice Address - Street 1:1801 SUSQUEHANNA RD
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-4622
Practice Address - Country:US
Practice Address - Phone:757-617-7659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0260872251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics