1720148158 NPI number — CEDARS THERAPY, LLC

Table of content: (NPI 1720148158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720148158 NPI number — CEDARS THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CEDARS THERAPY, 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:
CEDARS THERAPY, LLC
Provider Other Organization Name Type Code:
5
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:
1720148158
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
51 N 3RD ST # 302
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19106-4517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-922-0814
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 N 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19106-4508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-922-0814
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CONNOLLY
Authorized Official First Name:
IRENE
Authorized Official Middle Name:
MIZOBE
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
609-922-0814

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  PT006318L , 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: PT006318L . This is a "PHYSICAL THERAPY LICEN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 145254 . This is a "PROVIDER TRANSACTION ACCESS NUMBER GROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 148676ZCSX . This is a "MEDICARE GROUP MEMBER NUMBER OR INDIVIDUAL PROVIDER TRANSACTION ACCESS NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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