1275599409 NPI number — TRACY HORTER PHYSICAL THERAPY LLC

Table of content: MS. WENDY LYNN HOAG M.S. (NPI 1558488643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275599409 NPI number — TRACY HORTER PHYSICAL THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRACY HORTER PHYSICAL THERAPY LLC
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:
1275599409
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
919 CONESTOGA RD
Provider Second Line Business Mailing Address:
BLDG 3 STE 114
Provider Business Mailing Address City Name:
ROSEMONT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19010-1352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-527-0178
Provider Business Mailing Address Fax Number:
610-527-5770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
919 CONESTOGA RD
Provider Second Line Business Practice Location Address:
BLDG 3 STE 114
Provider Business Practice Location Address City Name:
ROSEMONT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19010-1352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-527-0178
Provider Business Practice Location Address Fax Number:
610-527-5770
Provider Enumeration Date:
04/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HORTER
Authorized Official First Name:
TRACY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
610-527-0178

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  PT002487L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3721810 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2175416000 . This is a "BC PERSONAL CHOICE KEYSTO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4338299 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 118923800 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1478828 . This is a "HIGHMARK BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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