Provider Demographics
NPI:1689006462
Name:IACOBUCCI, ALISON LOUISE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:LOUISE
Last Name:IACOBUCCI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 SUGARTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-3137
Mailing Address - Country:US
Mailing Address - Phone:484-582-0660
Mailing Address - Fax:484-582-0666
Practice Address - Street 1:215 SUGARTOWN RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3137
Practice Address - Country:US
Practice Address - Phone:484-582-0660
Practice Address - Fax:484-582-0666
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT022965174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist