Provider Demographics
NPI:1073903621
Name:CALVELLO, ANTHONY L IV (DPT)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:L
Last Name:CALVELLO
Suffix:IV
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 LONDONDERRY RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-5300
Mailing Address - Country:US
Mailing Address - Phone:717-657-7520
Mailing Address - Fax:717-657-7505
Practice Address - Street 1:4310 LONDONDERRY RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-5300
Practice Address - Country:US
Practice Address - Phone:717-657-7520
Practice Address - Fax:717-657-7505
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT024194225100000X
PATPT021616225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist