Basic Information
| Provider Information | |||||||||
| NPI: | 1124046578 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOOLEY | ||||||||
| FirstName: | BRENDA | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 W 10TH ST | ||||||||
| Address2: | |||||||||
| City: | MARCUS HOOK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190614513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108598850 | ||||||||
| FaxNumber: | 6108597876 | ||||||||
| Practice Location | |||||||||
| Address1: | 1331 E WYOMING AVE | ||||||||
| Address2: | SUITE 4120 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191243808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158311170 | ||||||||
| FaxNumber: | 2157447394 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 01/31/2011 | ||||||||
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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 | 225100000X | PT009983 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 30068870 | 01 | PA | KEYSTONE MERCY | OTHER | 306142 | 01 | UNISON | OTHER | 68640 | 01 | PA | HIGHMARK PABS | OTHER | 50065703 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 001697605-0008 | 05 | PA | MEDICAID | 0247464000 | 01 | PA | IBC | OTHER |