1588669758 NPI number — LEHIGH VALLEY PHYSICAL THERAPY CENTER, INC

Table of content: (NPI 1588669758)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588669758 NPI number — LEHIGH VALLEY PHYSICAL THERAPY CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEHIGH VALLEY PHYSICAL THERAPY CENTER, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588669758
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
421 S BEST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALNUTPORT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18088-1217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-760-1520
Provider Business Mailing Address Fax Number:
610-760-1721

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1597 LEHIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18103-3813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-791-4833
Provider Business Practice Location Address Fax Number:
610-791-1633
Provider Enumeration Date:
06/15/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HAMELL
Authorized Official First Name:
JEANETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS OFFICE MANAGER
Authorized Official Telephone Number:
610-760-1520

Provider Taxonomy Codes

  • Taxonomy code: 103TB0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC1900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0016806440004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".