Basic Information
| Provider Information | |||||||||
| NPI: | 1295785244 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ORTHOPEDIC AND SPORTS PHYSICAL THERAPY SERVICES, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | EXCEL PHYSICAL THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 BAINBRIDGE ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191471568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156293837 | ||||||||
| FaxNumber: | 2156295531 | ||||||||
| Practice Location | |||||||||
| Address1: | 734 E LANCASTER AVE | ||||||||
| Address2: | |||||||||
| City: | VILLANOVA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190851325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109641700 | ||||||||
| FaxNumber: | 6106882000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 05/12/2008 | ||||||||
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| AuthorizedOfficialLastName: | OSTROWSKI | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | ROBERT | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2156293837 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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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 |
ID Information
| ID | Type | State | Issuer | Description | 0444631000 | 01 | PA | BCBS HMO GROUP# | OTHER | 118100608 | 01 | PA | US DEPT OF LABOR | OTHER | 0213002 | 01 | PA | ORTHONET | OTHER | 966448 | 01 | PA | BCBS PPO GROUP# | OTHER | 99493 | 01 | PA | AETNA HMO GROUP# | OTHER | 4566762 | 01 | PA | AETNA PPO GROUP# | OTHER |