Basic Information
| Provider Information | |||||||||
| NPI: | 1316347164 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE TRAINING ROOM OF GARNET VALLEY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11 FORELOCK COURT | ||||||||
| Address2: | |||||||||
| City: | WEST CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568741166 | ||||||||
| FaxNumber: | 8568741188 | ||||||||
| Practice Location | |||||||||
| Address1: | 11 FORELOCK COURT | ||||||||
| Address2: | |||||||||
| City: | WEST CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568741166 | ||||||||
| FaxNumber: | 8568741188 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2014 | ||||||||
| LastUpdateDate: | 09/10/2014 | ||||||||
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| AuthorizedOfficialLastName: | HUGGARD | ||||||||
| AuthorizedOfficialFirstName: | AMANDA | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8568741166 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.