Basic Information
| Provider Information | |||||||||
| NPI: | 1235732587 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MACH | ||||||||
| FirstName: | JACQUELINE | ||||||||
| MiddleName: | AVILA | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3809 W CHESTER PIKE STE 150 | ||||||||
| Address2: | |||||||||
| City: | NEWTOWN SQUARE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190730259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103595640 | ||||||||
| FaxNumber: | 6103591519 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 SPRINGHOUSE DR STE 201 | ||||||||
| Address2: | |||||||||
| City: | COLLEGEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194264021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104894745 | ||||||||
| FaxNumber: | 6104894209 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2020 | ||||||||
| LastUpdateDate: | 01/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT029048 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.