1386694396 NPI number — ORTHOPEDIC AND SPORTS PHYSICAL THERAPY SERVICES, INC.

Table of content: (NPI 1386694396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386694396 NPI number — ORTHOPEDIC AND SPORTS PHYSICAL THERAPY SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPEDIC AND SPORTS PHYSICAL THERAPY SERVICES, 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:
EXCEL 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:
1386694396
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 BAINBRIDGE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19147-1568
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-629-3837
Provider Business Mailing Address Fax Number:
215-629-5531

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
331 WILMINGTON PIKE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
GLEN MILLS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19342-2277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-558-5866
Provider Business Practice Location Address Fax Number:
610-558-6103
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OSTROWSKI
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
215-629-3837

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 966448 . This is a "BCBS PPO GROUP#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 118100606 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0213006 . This is a "ORTHONET" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0444631000 . This is a "BCBS HMO GROUP #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 99493 . This is a "AETNA HMO GROUP#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4566762 . This is a "AETNA PPO GROUP#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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