Basic Information
| Provider Information | |||||||||
| NPI: | 1073053682 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PARK | ||||||||
| FirstName: | HILARY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 E LANCASTER AVE | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | ARDMORE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190033209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4842976491 | ||||||||
| FaxNumber: | 6108967218 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 E LANCASTER AVE | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | ARDMORE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190033209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4842976491 | ||||||||
| FaxNumber: | 6108967218 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2017 | ||||||||
| LastUpdateDate: | 03/01/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | PT025884 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.