Provider Demographics
NPI:1417364274
Name:PEARCE PEARSON, PHILIP PERRY
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:PERRY
Last Name:PEARCE PEARSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 S JEFFERSON ST
Mailing Address - Street 2:#2
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-8055
Mailing Address - Country:US
Mailing Address - Phone:484-240-9225
Mailing Address - Fax:
Practice Address - Street 1:712 S JEFFERSON ST
Practice Address - Street 2:#2
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-8055
Practice Address - Country:US
Practice Address - Phone:484-240-9225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA25823601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health