1003095324 NPI number — PERSONAL TOUCH REHAB AND FITNESS

Table of content: (NPI 1003095324)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003095324 NPI number — PERSONAL TOUCH REHAB AND FITNESS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERSONAL TOUCH REHAB AND FITNESS
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:
AMERICAN/DUTCH PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
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:
1003095324
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3538 ORIOLE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGDON VALLEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19006-3412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-635-5575
Provider Business Mailing Address Fax Number:
215-635-5456

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 JAMES WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHAMPTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18966-3818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-635-5575
Provider Business Practice Location Address Fax Number:
215-635-5456
Provider Enumeration Date:
11/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BRODSKY
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
215-635-5575

Provider Taxonomy Codes

  • Taxonomy code: 2251N0400X , with the licence number:  PT015515 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 305S00000X , with the licence number: PT015515 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 078730 . This is a "PTAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1019816960001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 078730 . This is a "MEDICARE GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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