Basic Information
| Provider Information | |||||||||
| NPI: | 1417909664 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | AMIT | ||||||||
| FirstName: | OPHER | ||||||||
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| NamePrefix: | MR. | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 W 10TH ST | ||||||||
| Address2: | |||||||||
| City: | MARCUS HOOK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190614513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108598850 | ||||||||
| FaxNumber: | 6108597876 | ||||||||
| Practice Location | |||||||||
| Address1: | 2966 STREET RD | ||||||||
| Address2: | |||||||||
| City: | BENSALEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190202604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156392639 | ||||||||
| FaxNumber: | 2159292464 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 11/09/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT015803 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | DAPT001137 | PA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 101004983 0002 | 05 | PA | MEDICAID | 30052899 | 01 | PA | KEYSTONE MERCY | OTHER | 2301064000 | 01 | PA | IBC | OTHER | 001624318 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 101004983-0002 | 05 | PA | MEDICAID |