Provider Demographics
NPI:1417056813
Name:VIETRI, ROBERT (LPT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:VIETRI
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 DEKALB ST
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-3404
Mailing Address - Country:US
Mailing Address - Phone:610-279-8686
Mailing Address - Fax:610-279-1588
Practice Address - Street 1:1308 DEKALB ST
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-3404
Practice Address - Country:US
Practice Address - Phone:610-279-8686
Practice Address - Fax:610-279-1588
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT003525L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0049545000OtherIBX
PA040120Medicare PIN