Provider Demographics
NPI:1194072322
Name:MCANALLY, CHARLES T
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:T
Last Name:MCANALLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 MCDERMOTT DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4064
Mailing Address - Country:US
Mailing Address - Phone:484-356-9401
Mailing Address - Fax:
Practice Address - Street 1:525 W CHESTER PIKE
Practice Address - Street 2:SUITE 202
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-4500
Practice Address - Country:US
Practice Address - Phone:610-446-8410
Practice Address - Fax:610-446-8554
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0123912251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic