Provider Demographics
NPI:1417026113
Name:SEASHOLTZ, MAUREEN H (PT)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:H
Last Name:SEASHOLTZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 MORNINGSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-2961
Mailing Address - Country:US
Mailing Address - Phone:610-995-2966
Mailing Address - Fax:
Practice Address - Street 1:1 BALA PLZ
Practice Address - Street 2:SUITE 134
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1403
Practice Address - Country:US
Practice Address - Phone:610-668-4055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-013129-L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1586229OtherHIGHMARK BLUE SHIELD
PA2264772000OtherINDEPENDENCE BLUE CROSS