Basic Information
| Provider Information | |||||||||
| NPI: | 1376182170 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALLEY PHYSICAL THERAPY PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 69 | ||||||||
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| City: | JAMISON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189290069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153607824 | ||||||||
| FaxNumber: | 2155015108 | ||||||||
| Practice Location | |||||||||
| Address1: | 1810 COUNTY LINE RD STE 400 | ||||||||
| Address2: | |||||||||
| City: | HUNTINGDON VALLEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190061720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153607824 | ||||||||
| FaxNumber: | 2155015108 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2019 | ||||||||
| LastUpdateDate: | 07/05/2022 | ||||||||
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| AuthorizedOfficialLastName: | WALSH | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2674068309 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPT | ||||||||
| NPICertificationDate: | 06/28/2022 | ||||||||
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 | 1027050340003 | 05 | PA | MEDICAID |