Provider Demographics
NPI:1265789374
Name:PETHERBRIDGE, ANNE LOUISE (DPT)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:LOUISE
Last Name:PETHERBRIDGE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 MICHAEL RD
Mailing Address - Street 2:
Mailing Address - City:MEADOWBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2524
Mailing Address - Country:US
Mailing Address - Phone:215-886-7596
Mailing Address - Fax:
Practice Address - Street 1:5457 WAYNE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-3433
Practice Address - Country:US
Practice Address - Phone:267-335-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT003375L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist