Provider Demographics
NPI:1912493768
Name:CADWALLADER, EMMA PERRY (RPT)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:PERRY
Last Name:CADWALLADER
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 ROUNDTREE DR
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:AL
Mailing Address - Zip Code:36272-5892
Mailing Address - Country:US
Mailing Address - Phone:256-447-8258
Mailing Address - Fax:256-447-8258
Practice Address - Street 1:30 ROUNDTREE DR
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:AL
Practice Address - Zip Code:36272-5892
Practice Address - Country:US
Practice Address - Phone:256-447-8258
Practice Address - Fax:256-447-8258
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH8932225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY147116677OtherDRIVER'S LICENSE
ALPTH8932OtherAL PT LICENSE