Provider Demographics
NPI:1790029270
Name:INFANTE, MAUREEN ANN MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:MAUREEN ANN
Middle Name:MARIE
Last Name:INFANTE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 STATE RD
Mailing Address - Street 2:
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1624
Mailing Address - Country:US
Mailing Address - Phone:267-424-4203
Mailing Address - Fax:505-468-3727
Practice Address - Street 1:3250 STATE RD
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1624
Practice Address - Country:US
Practice Address - Phone:215-257-2751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE1003079225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant