Lucille Renee Derose, PTA
NPI #1912025826 in Haverford, Pennsylvania
Provider Information
- NPI Number
- 1912025826
- Entity Type
- Individual
- Name
- Lucille Renee Derose, PTA
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Physical Therapy Assistant
- Credential
- PTA
- Enumeration Date
- Mar 27, 2007
- Last Updated
- Sep 10, 2008
Practice Location
- Address
- 551 W LANCASTER AVE
- City
- Haverford
- State
- Pennsylvania
- ZIP Code
- 19041-1419
- Phone
- (180) 055-0921
Specialties & Taxonomy Codes
| Specialty |
|---|
| Physical Therapy Assistant |
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