1083882450 NPI number — BACK IN ACTION PHYSICAL THERAPY AND FITNESS CENTER,LLC

Table of content: (NPI 1083882450)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083882450 NPI number — BACK IN ACTION PHYSICAL THERAPY AND FITNESS CENTER,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BACK IN ACTION PHYSICAL THERAPY AND FITNESS CENTER,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:
1083882450
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1407 EISENHOWER BLVD
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
JOHNSTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15904-3262
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-684-0702
Provider Business Mailing Address Fax Number:
814-684-0426

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BUILDING II, ROUTE 220
Provider Second Line Business Practice Location Address:
TIPTON MEDICAL & DIAGNOSTIC CENTER
Provider Business Practice Location Address City Name:
TIPTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-684-0702
Provider Business Practice Location Address Fax Number:
814-684-0426
Provider Enumeration Date:
02/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LATCHFORD
Authorized Official First Name:
LYNNETTE
Authorized Official Middle Name:
K
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
814-684-0702

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT015991L , 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: PT015991L . This is a "LICENSE NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com