Provider Demographics
NPI:1649528506
Name:IMMERMAN, ILAN (DPT)
Entity type:Individual
Prefix:DR
First Name:ILAN
Middle Name:
Last Name:IMMERMAN
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 1:319 W COUNTY LINE RD
Mailing Address - Street 2:STE 9
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-1605
Mailing Address - Country:US
Mailing Address - Phone:215-470-1652
Mailing Address - Fax:610-471-0488
Practice Address - Street 1:319 W COUNTY LINE RD
Practice Address - Street 2:STE 9
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040-1605
Practice Address - Country:US
Practice Address - Phone:215-470-1652
Practice Address - Fax:610-471-0488
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT27430225100000X
PAPT023465225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist