Provider Demographics
NPI:1922381334
Name:MACASADIA, EHRL THOMAS (DPT)
Entity Type:Individual
Prefix:
First Name:EHRL
Middle Name:THOMAS
Last Name:MACASADIA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7618 OGONTZ AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-1817
Mailing Address - Country:US
Mailing Address - Phone:267-323-2778
Mailing Address - Fax:267-323-2774
Practice Address - Street 1:7618 OGONTZ AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19150-1817
Practice Address - Country:US
Practice Address - Phone:267-323-2778
Practice Address - Fax:267-323-2774
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT021640225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist