Provider Demographics
NPI:1154039402
Name:LONGACRE, TERESA MICHELE (PTA)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:MICHELE
Last Name:LONGACRE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 MILL RD
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:17086-9146
Mailing Address - Country:US
Mailing Address - Phone:717-503-6677
Mailing Address - Fax:
Practice Address - Street 1:9627 ROUTE 35
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT MILLS
Practice Address - State:PA
Practice Address - Zip Code:17853-8409
Practice Address - Country:US
Practice Address - Phone:570-539-4311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI001546225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant