Provider Demographics
NPI:1053531715
Name:DERUOSI, KARIN KECK (MSPT)
Entity type:Individual
Prefix:MS
First Name:KARIN
Middle Name:KECK
Last Name:DERUOSI
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MATTISON AVE
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-4623
Mailing Address - Country:US
Mailing Address - Phone:215-542-0193
Mailing Address - Fax:
Practice Address - Street 1:602 S BETHLEHEM PIKE STE A2
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-5800
Practice Address - Country:US
Practice Address - Phone:215-643-7884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT002369E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist