Provider Demographics
NPI:1407415722
Name:MACH, THANH (DPT)
Entity Type:Individual
Prefix:DR
First Name:THANH
Middle Name:
Last Name:MACH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:THANH
Other - Middle Name:
Other - Last Name:MACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6787 MARKET ST STE 103
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-1848
Mailing Address - Country:US
Mailing Address - Phone:484-462-7013
Mailing Address - Fax:610-886-0722
Practice Address - Street 1:6787 MARKET ST STE 103
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-1848
Practice Address - Country:US
Practice Address - Phone:610-352-8000
Practice Address - Fax:610-886-0722
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT028221225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist