Provider Demographics
NPI:1689794588
Name:GNOFFO, ROSALEEN CREEDON (PT, MS, DPT, PCS)
Entity Type:Individual
Prefix:MRS
First Name:ROSALEEN
Middle Name:CREEDON
Last Name:GNOFFO
Suffix:
Gender:F
Credentials:PT, MS, DPT, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:749 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-2741
Mailing Address - Country:US
Mailing Address - Phone:267-639-6727
Mailing Address - Fax:
Practice Address - Street 1:1636 SOUTH STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146
Practice Address - Country:US
Practice Address - Phone:215-545-0320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019402-1225100000X
PAPT0196522251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist