Provider Demographics
NPI:1912493768
Name:CADWALLADER, EMMA PERRY (RPT)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:PERRY
Last Name:CADWALLADER
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 DURLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-1938
Mailing Address - Country:US
Mailing Address - Phone:607-731-4405
Mailing Address - Fax:
Practice Address - Street 1:862 MEINECKE AVE STE 101
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-3702
Practice Address - Country:US
Practice Address - Phone:805-619-0414
Practice Address - Fax:805-549-5253
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24050208100000X
ALPTH8932225100000X
CAPT305645225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY147116677OtherDRIVER'S LICENSE
ALPTH8932OtherAL PT LICENSE