1649234923 NPI number — PAIN RELIEF AND PHYSICAL THERAPY, INC.

Table of content: (NPI 1649234923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649234923 NPI number — PAIN RELIEF AND PHYSICAL THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAIN RELIEF AND PHYSICAL THERAPY, 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:
1649234923
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
316 VALLEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAVERTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19083-5434
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-789-1599
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
57 W EAGLE RD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
HAVERTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19083-2234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-789-9887
Provider Business Practice Location Address Fax Number:
610-789-9883
Provider Enumeration Date:
04/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
O'HALLORAN
Authorized Official First Name:
BRYAN
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
610-789-9887

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT-002907-E , 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: 445391000 . This is a "KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: CK5209 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: I68311 . This is a "AMERIHEALTH GRP #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1017072 . This is a "AETNA GROUP PROV. #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000968311 . This is a "BS/BC GROUP #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0214300 . This is a "ORTHONET GRP #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0445391000 . This is a "PERSONALCHOICE PROVIDER#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com