Basic Information
| Provider Information | |||||||||
| NPI: | 1699702365 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELLERT | ||||||||
| FirstName: | MELANIE | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | FADER | ||||||||
| OtherFirstName: | MELANIE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 400 MCFARLAN RD | ||||||||
| Address2: | |||||||||
| City: | KENNETT SQUARE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193482477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109254901 | ||||||||
| FaxNumber: | 6109254906 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 MCFARLAN RD | ||||||||
| Address2: | |||||||||
| City: | KENNETT SQUARE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193482477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109254901 | ||||||||
| FaxNumber: | 6109254906 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 03/02/2011 | ||||||||
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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 | J1-0001809 | DE | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT019683 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.