Provider Demographics
NPI:1831210772
Name:DAMANY, SUPARNA K (MSPT, CHT)
Entity type:Individual
Prefix:MS
First Name:SUPARNA
Middle Name:K
Last Name:DAMANY
Suffix:
Gender:F
Credentials:MSPT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 S CEDAR CREST BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-5400
Mailing Address - Country:US
Mailing Address - Phone:610-821-9135
Mailing Address - Fax:
Practice Address - Street 1:1040 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-5400
Practice Address - Country:US
Practice Address - Phone:610-821-9135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT002562E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA034639Medicare PIN