Provider Demographics
NPI:1710097365
Name:PANTANELLI, VALERIE
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:PANTANELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-1418
Mailing Address - Country:US
Mailing Address - Phone:203-788-0582
Mailing Address - Fax:
Practice Address - Street 1:110 N 7TH ST
Practice Address - Street 2:
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-1501
Practice Address - Country:US
Practice Address - Phone:717-731-6094
Practice Address - Fax:717-731-6199
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA11759009OtherCAQH
PA023635OtherPA LICENSE NUMBER
NY029223OtherNEW YORK LICENSE NUMBER
MD21890OtherLICENSE #