Provider Demographics
NPI:1962270892
Name:SERVIN, ROSALIE (PT)
Entity type:Individual
Prefix:
First Name:ROSALIE
Middle Name:
Last Name:SERVIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ROSALIE
Other - Middle Name:
Other - Last Name:HUTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2100 MACK BLVD FL 4
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-5622
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:707 HAMILTON ST FL 4
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18101-2407
Practice Address - Country:US
Practice Address - Phone:484-862-3001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT030909225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist