Basic Information
| Provider Information | |||||||||
| NPI: | 1467751503 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OPDAM | ||||||||
| FirstName: | MARINA | ||||||||
| MiddleName: | H. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 676 DEKALB PIKE | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | BLUE BELL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194221223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102700370 | ||||||||
| FaxNumber: | 6102700374 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 HORIZON DR | ||||||||
| Address2: | SUITE 102E | ||||||||
| City: | CHALFONT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189143966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157120300 | ||||||||
| FaxNumber: | 2157129040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2011 | ||||||||
| LastUpdateDate: | 03/15/2011 | ||||||||
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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 | 2251X0800X | PT012641L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.