Provider Demographics
NPI:1588610737
Name:ARQUITOLA, AILEEN MALLARI (PT)
Entity Type:Individual
Prefix:
First Name:AILEEN
Middle Name:MALLARI
Last Name:ARQUITOLA
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 1:1919 CHESTNUT ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-3401
Mailing Address - Country:US
Mailing Address - Phone:215-564-1110
Mailing Address - Fax:215-564-1130
Practice Address - Street 1:1919 CHESTNUT ST
Practice Address - Street 2:SUITE 104
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-3401
Practice Address - Country:US
Practice Address - Phone:215-564-1110
Practice Address - Fax:215-564-1130
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018918225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA114758WQNMedicare PIN