Provider Demographics
NPI:1972857399
Name:QUISUMBING, LARA (DPT)
Entity Type:Individual
Prefix:MRS
First Name:LARA
Middle Name:
Last Name:QUISUMBING
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:LARA
Other - Middle Name:Y
Other - Last Name:HAMAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:120 W GERMANTOWN PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1420
Mailing Address - Country:US
Mailing Address - Phone:610-270-0370
Mailing Address - Fax:610-270-0374
Practice Address - Street 1:734 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:VILLANOVA
Practice Address - State:PA
Practice Address - Zip Code:19085-1325
Practice Address - Country:US
Practice Address - Phone:610-964-1700
Practice Address - Fax:610-688-2000
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0224612251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic