Provider Demographics
NPI:1548553514
Name:DEARDORFF, PAUL CLAYTON (PTA)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:CLAYTON
Last Name:DEARDORFF
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:6596 ORPHANAGE RD
Mailing Address - City:QUINCY
Mailing Address - State:PA
Mailing Address - Zip Code:17247
Mailing Address - Country:US
Mailing Address - Phone:717-677-9921
Mailing Address - Fax:
Practice Address - Street 1:6596 ORPHANAGE RD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:PA
Practice Address - Zip Code:17247
Practice Address - Country:US
Practice Address - Phone:717-762-6500
Practice Address - Fax:717-762-6501
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI002794225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant