1891753752 NPI number — GO SPORT PHYSICAL THERAPY INC

Table of content: (NPI 1891753752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891753752 NPI number — GO SPORT PHYSICAL THERAPY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GO SPORT PHYSICAL THERAPY INC
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:
1891753752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16C DEATRICK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GETTYSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17325-6958
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-337-3300
Provider Business Mailing Address Fax Number:
717-337-2977

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16C DEATRICK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GETTYSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17325-6958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-337-3300
Provider Business Practice Location Address Fax Number:
717-337-2977
Provider Enumeration Date:
05/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEWIS
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
717-337-3300

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: 1523358 . This is a "GATEWAY GROUP #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 646309 . This is a "HIGHMARK BS GROUP #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: LP83 . This is a "CAREFIRST GROUP #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: T709 . This is a "NAT'L CAP CARE GROUP#" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 02442200 . This is a "CAPITAL BC GROUP PROV #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 131854 . This is a "MEDPLUS GROUP #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 20021541 . This is a "AMERIHEALTH MERCY GRP#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 206108 . This is a "HEALTH AMER/ASSUR GRP#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 364765200 . This is a "US DEPT OF LABOR GRP#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0019322220006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2119160 . This is a "AETNA GROUP PROV #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com