1184062531 NPI number — BACK 2 ACTION PHYSICAL THERAPY, PC

Table of content: MRS. LORI ANN SHAW LSCSW (NPI 1225108616)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184062531 NPI number — BACK 2 ACTION PHYSICAL THERAPY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BACK 2 ACTION PHYSICAL THERAPY, PC
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:
1184062531
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
625 LINCOLN AVE
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
N CHARLEROI
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15022-2451
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-483-2159
Provider Business Mailing Address Fax Number:
724-489-4758

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14302 BARTON BLVD SW
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
CUMBERLAND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21502-5825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-483-2159
Provider Business Practice Location Address Fax Number:
724-489-4758
Provider Enumeration Date:
06/07/2013

Additional Information

Authorized Official

Authorized Official Last Name:
HENSON
Authorized Official First Name:
JODY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
724-483-2159

Provider Taxonomy Codes

  • Taxonomy code: 111NR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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