Provider Demographics
NPI:1609912278
Name:VALLE, ERASTO (MSPT)
Entity Type:Individual
Prefix:MR
First Name:ERASTO
Middle Name:
Last Name:VALLE
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 ABBEY TER
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-2902
Mailing Address - Country:US
Mailing Address - Phone:305-297-6836
Mailing Address - Fax:
Practice Address - Street 1:200 E STATE ST
Practice Address - Street 2:SUITE 108
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3434
Practice Address - Country:US
Practice Address - Phone:484-444-0820
Practice Address - Fax:610-566-1572
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist