Provider Demographics
NPI:1912104639
Name:MCARDLE, KELLY DUSZAK (PT, DPT, CERTMDT)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:DUSZAK
Last Name:MCARDLE
Suffix:
Gender:F
Credentials:PT, DPT, CERTMDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 S 7TH ST
Mailing Address - Street 2:APT 3
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1411
Mailing Address - Country:US
Mailing Address - Phone:215-748-9160
Mailing Address - Fax:215-748-9724
Practice Address - Street 1:501 SOUTH 54TH STREET
Practice Address - Street 2:SUITE 127
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143
Practice Address - Country:US
Practice Address - Phone:215-748-9160
Practice Address - Fax:215-748-9724
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011690174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist