Provider Demographics
NPI:1134751910
Name:DITTMEIER, JACQUELYN (DPT)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:DITTMEIER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10980 NORCOM RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-2302
Mailing Address - Country:US
Mailing Address - Phone:215-677-1149
Mailing Address - Fax:215-677-1169
Practice Address - Street 1:10980 NORCOM RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-2302
Practice Address - Country:US
Practice Address - Phone:215-677-1149
Practice Address - Fax:215-677-1169
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT028321225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist