1376508077 NPI number — HUGHES PHYSICAL THERAPY SERVICES, LLC

Table of content: (NPI 1376508077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376508077 NPI number — HUGHES PHYSICAL THERAPY SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUGHES PHYSICAL THERAPY SERVICES, 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:
1376508077
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 FOREST RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ACME
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15610-1218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-547-3657
Provider Business Mailing Address Fax Number:
724-547-5586

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3802 STATE ROUTE 31
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
DONEGAL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15628-4033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-593-8880
Provider Business Practice Location Address Fax Number:
724-593-8882
Provider Enumeration Date:
04/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HUGHES
Authorized Official First Name:
MARK
Authorized Official Middle Name:
GREGORY
Authorized Official Title or Position:
PRESIDENT AND OWNER
Authorized Official Telephone Number:
724-593-8880

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT015390 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X , with the licence number: OC001781L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7385679 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1013719190001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1600108 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 259237 . This is a "HEALTH AMERICA/HEALTH ASS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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