1548450653 NPI number — OLD TOWNE PHYSICAL THERAPY LIMITED PARTNERSHIP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548450653 NPI number — OLD TOWNE PHYSICAL THERAPY LIMITED PARTNERSHIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OLD TOWNE PHYSICAL THERAPY LIMITED PARTNERSHIP
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:
1548450653
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34434 KING STREET ROW
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
LEWES
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19958-4787
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-645-0312
Provider Business Mailing Address Fax Number:
302-645-0342

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34434 KING STREET ROW
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
LEWES
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19958-4787
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-645-0312
Provider Business Practice Location Address Fax Number:
302-645-0342
Provider Enumeration Date:
07/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KING
Authorized Official First Name:
JANNA
Authorized Official Middle Name:
P
Authorized Official Title or Position:
VP, AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
713-297-7000

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)





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