1487609681 NPI number — RIDGE PHYSICAL THERAPY LLC

Table of content: DR. TRACY G. SANSON M.D. (NPI 1891721197)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487609681 NPI number — RIDGE PHYSICAL THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIDGE PHYSICAL 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:
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:
1487609681
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2525 W MAIN ST
Provider Second Line Business Mailing Address:
1ST FLOOR
Provider Business Mailing Address City Name:
NORRISTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19403-6001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-630-8878
Provider Business Mailing Address Fax Number:
610-630-1976

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2525 W MAIN ST
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
NORRISTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19403-6001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-630-8878
Provider Business Practice Location Address Fax Number:
610-630-1976
Provider Enumeration Date:
05/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STROBEL
Authorized Official First Name:
REGINA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
PHYSICAL THERAPIST/OWNER
Authorized Official Telephone Number:
610-630-8878

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT013763L , 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)





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