1619911914 NPI number — MONTGOMERY COUNTY REHABILITATION & SPORTS THERAPY, P.C.

Table of content: (NPI 1619911914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619911914 NPI number — MONTGOMERY COUNTY REHABILITATION & SPORTS THERAPY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTGOMERY COUNTY REHABILITATION & SPORTS THERAPY, P.C.
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:
1619911914
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
170 W GERMANTOWN PIKE STE C3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORRISTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19401-1389
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-279-6290
Provider Business Mailing Address Fax Number:
610-279-7029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
170 W GERMANTOWN PIKE STE C3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORRISTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19401-1389
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-279-6290
Provider Business Practice Location Address Fax Number:
610-279-7029
Provider Enumeration Date:
06/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GIULIANI
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
C.F.O. / ADMINISTRATOR
Authorized Official Telephone Number:
215-885-2022

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)

  • Identifier: 000567078 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0437564000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1033495 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 54079 . This is a "AETNA HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 43-1622239M0209 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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