Basic Information
| Provider Information | |||||||||
| NPI: | 1487188702 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | MADDATU | ||||||||
| FirstName: | HELOISE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 427 THATCHER RD | ||||||||
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| City: | SPRINGFIELD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190642911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7324064601 | ||||||||
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| Practice Location | |||||||||
| Address1: | 491 JOHN YOUNG WAY | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | EXTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193412567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105247251 | ||||||||
| FaxNumber: | 6102801506 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2017 | ||||||||
| LastUpdateDate: | 06/05/2017 | ||||||||
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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 | 225100000X | PT025729 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.