1912091190 NPI number — CONSHOHOCKEN PHYSICAL THERAPY INC

Table of content: (NPI 1912091190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912091190 NPI number — CONSHOHOCKEN PHYSICAL THERAPY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONSHOHOCKEN 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:
1912091190
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 E 11TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONSHOHOCKEN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19428-1555
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-828-7595
Provider Business Mailing Address Fax Number:
610-828-7505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 E 11TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONSHOHOCKEN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19428-1555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-828-7595
Provider Business Practice Location Address Fax Number:
610-828-7505
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CAUCCI
Authorized Official First Name:
DESIREA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
610-828-7595

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  PT015693 , 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: 17588 . This is a "AMERIHEALTH ADMINISTRATOR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3498858 . This is a "AETNA NON PAR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1417588 . This is a "HIGHMARK BS INDIVIDUAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0220700 . This is a "ORTHONET" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 700260 . This is a "UNITED HEALTHCARE/ACN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1732275 . This is a "HIGHMARK BS GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5630094 . This is a "FIRST HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 737511 . This is a "NCPPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7385670 . This is a "AWCA INDIVIDUAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2402306 . This is a "INDEPENDENCE BC GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1881699213 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2103996000 . This is a "INDEPENDENCE BC INDIV" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7051525 . This is a "AWCA GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 8279722 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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