Provider Demographics
NPI:1407668791
Name:CANTWELL, CARLEY
Entity type:Individual
Prefix:
First Name:CARLEY
Middle Name:
Last Name:CANTWELL
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 1:1936 W POINT PIKE
Mailing Address - Street 2:
Mailing Address - City:UPPER GWYNEDD
Mailing Address - State:PA
Mailing Address - Zip Code:19446-5617
Mailing Address - Country:US
Mailing Address - Phone:215-542-9517
Mailing Address - Fax:
Practice Address - Street 1:728 NORRISTOWN RD
Practice Address - Street 2:
Practice Address - City:LOWER GWYNEDD
Practice Address - State:PA
Practice Address - Zip Code:19002-2125
Practice Address - Country:US
Practice Address - Phone:855-565-1996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC019149208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation