1346477981 NPI number — DYNAMIC THERAPY SERVICES OF PENNSYLVANIA LLC

Table of content: (NPI 1346477981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346477981 NPI number — DYNAMIC THERAPY SERVICES OF PENNSYLVANIA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DYNAMIC THERAPY SERVICES OF PENNSYLVANIA 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:
6
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:
1346477981
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 W 10TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARCUS HOOK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19061-4513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-859-9111
Provider Business Mailing Address Fax Number:
610-859-7876

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4948 PENNELL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19014-1867
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-494-8730
Provider Business Practice Location Address Fax Number:
610-494-9671
Provider Enumeration Date:
06/22/2009

Additional Information

Authorized Official

Authorized Official Last Name:
DOWELL
Authorized Official First Name:
DARREN
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
610-859-9111

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)





Copyright © 2007-2025 www.npivalidator.com