1619158557 NPI number — PROFESSIONAL PHYSICAL THERAPY SERVICES INC

Table of content: (NPI 1619158557)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619158557 NPI number — PROFESSIONAL PHYSICAL THERAPY SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROFESSIONAL PHYSICAL THERAPY SERVICES 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:
PPTS INC
Provider Other Organization Name Type Code:
3
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:
1619158557
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 MILL RACE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18940-2810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-860-2888
Provider Business Mailing Address Fax Number:
215-860-7458

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 MILL RACE LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18940-2810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-860-2888
Provider Business Practice Location Address Fax Number:
215-860-7458
Provider Enumeration Date:
11/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
THERESE
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT AND OWNER
Authorized Official Telephone Number:
215-860-2888

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT005324L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: 40QA00305800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0211600 . This is a "ORTHOMET" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 204305 . This is a "MULTIPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: PR1591819 . This is a "HIGHMARK BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0211600 . This is a "CIGNAHEALTHCARE OF PA INC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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