Provider Demographics
NPI:1891905576
Name:ADDARI, NANDO C (PT)
Entity Type:Individual
Prefix:MR
First Name:NANDO
Middle Name:C
Last Name:ADDARI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 DEKALB PIKE
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-3348
Mailing Address - Country:US
Mailing Address - Phone:610-275-0330
Mailing Address - Fax:610-275-2455
Practice Address - Street 1:1524 DEKALB PIKE
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-3348
Practice Address - Country:US
Practice Address - Phone:610-275-0330
Practice Address - Fax:610-275-2455
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007901L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABCBSOther0263403000
PA829821OtherAETNA
PABCBSOther0263403000
PA026739NV7Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL ID