Basic Information
| Provider Information | |||||||||
| NPI: | 1225595333 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LALIBERTE | ||||||||
| FirstName: | RYAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 BENJAMIN FRANKLIN PKWY APT E811 | ||||||||
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| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191306701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327666809 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1400 N PROVIDENCE RD STE 210 | ||||||||
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| City: | MEDIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190632049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108911636 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2019 | ||||||||
| LastUpdateDate: | 02/25/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.