Basic Information
| Provider Information | |||||||||
| NPI: | 1164877254 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PURSUE PHYSICAL THERAPY AND WELLNESS CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 W GERMANTOWN PIKE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PLYMOUTH MEETING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194621420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102700370 | ||||||||
| FaxNumber: | 6102700374 | ||||||||
| Practice Location | |||||||||
| Address1: | 649 N LEWIS RD | ||||||||
| Address2: | SUITE 225 | ||||||||
| City: | ROYERSFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194681234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105690004 | ||||||||
| FaxNumber: | 6105690005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2016 | ||||||||
| LastUpdateDate: | 04/26/2016 | ||||||||
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| AuthorizedOfficialLastName: | BONGIORNO | ||||||||
| AuthorizedOfficialFirstName: | KAMALA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6102700370 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.