Basic Information
| Provider Information | |||||||||
| NPI: | 1447424064 | ||||||||
| 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: | |||||||||
| Practice Location | |||||||||
| Address1: | 9337 KREWSTOWN ROAD | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156293837 | ||||||||
| FaxNumber: | 2156295531 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2008 | ||||||||
| LastUpdateDate: | 05/12/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | OSTROWSKI | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | ROBERT | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO / OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2156293837 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | PT | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 4566762 | 01 | PA | AETNA PPO | OTHER | 0099493 | 01 | PA | AETNA HMO | OTHER | 966448 | 01 | PA | BCBS PPO | OTHER | 044631000 | 01 | PA | IBC - PERSONAL CHOICE / KEYSTONE | OTHER | A2590262 | 01 | PA | OXFORD | OTHER |