Provider Demographics
NPI:1568675122
Name:DEPETRIS, THERESA LEAHEY (PT)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:LEAHEY
Last Name:DEPETRIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 WAVERLY RD
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1827
Mailing Address - Country:US
Mailing Address - Phone:610-527-5670
Mailing Address - Fax:
Practice Address - Street 1:721 WAVERLY RD
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1827
Practice Address - Country:US
Practice Address - Phone:610-527-5670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT000901E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist