Provider Demographics
NPI:1538172796
Name:VIRNELSON, TONIA (PT)
Entity type:Individual
Prefix:MRS
First Name:TONIA
Middle Name:
Last Name:VIRNELSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TONIA
Other - Middle Name:
Other - Last Name:MASTROCOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3809 W CHESTER PIKE STE 150
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-0259
Mailing Address - Country:US
Mailing Address - Phone:610-359-5640
Mailing Address - Fax:610-359-1519
Practice Address - Street 1:2004 SPROUL RD STE 100
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3511
Practice Address - Country:US
Practice Address - Phone:610-359-1580
Practice Address - Fax:610-359-1050
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016429225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAKEYOther2353042000
PAMA1678965OtherPABS