Provider Demographics
NPI:1760431308
Name:RAPHAEL, CHARI M (PT)
Entity Type:Individual
Prefix:
First Name:CHARI
Middle Name:M
Last Name:RAPHAEL
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 1:737 EASTWIND CIR
Mailing Address - Street 2:
Mailing Address - City:DRESHER
Mailing Address - State:PA
Mailing Address - Zip Code:19025-1437
Mailing Address - Country:US
Mailing Address - Phone:215-782-8760
Mailing Address - Fax:215-635-7130
Practice Address - Street 1:8080 OLD YORK RD
Practice Address - Street 2:SUITE 208
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1421
Practice Address - Country:US
Practice Address - Phone:215-782-8760
Practice Address - Fax:215-635-7130
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005082L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA09371UF9Medicare ID - Type Unspecified