Provider Demographics
NPI:1376845875
Name:CORDUWA, JEFFREY (RPT)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:CORDUWA
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 W DEKALB PIKE
Mailing Address - Street 2:APT # B414
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2421
Mailing Address - Country:US
Mailing Address - Phone:484-368-4350
Mailing Address - Fax:
Practice Address - Street 1:251 W. DEKALB PK
Practice Address - Street 2:APT B414
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406
Practice Address - Country:US
Practice Address - Phone:484-368-4350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT020357225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist