Provider Demographics
NPI:1558044743
Name:MCDEVITT, LAURA JEAN (PTA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JEAN
Last Name:MCDEVITT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 PRICE AVE APT L12
Mailing Address - Street 2:
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-1841
Mailing Address - Country:US
Mailing Address - Phone:267-506-3615
Mailing Address - Fax:
Practice Address - Street 1:100 WITMER RD STE 180
Practice Address - Street 2:
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044-2648
Practice Address - Country:US
Practice Address - Phone:215-481-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI006441225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant