Basic Information
Provider Information | |||||||||
NPI: | 1629035431 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | NO LIMITS PHYSICAL THERAPY & SPORTS MEDICINE CENTER, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | HC 6 BOX 6046 | ||||||||
Address2: | 25 19 RT 6 | ||||||||
City: | HAWLEY | ||||||||
State: | PA | ||||||||
PostalCode: | 184289100 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5702265680 | ||||||||
FaxNumber: | 5702265682 | ||||||||
Practice Location | |||||||||
Address1: | HC 6 BOX 6046 | ||||||||
Address2: | THE LAKE'S NORTH POLE | ||||||||
City: | HAWLEY | ||||||||
State: | PA | ||||||||
PostalCode: | 184289100 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5702265680 | ||||||||
FaxNumber: | 5702265682 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/26/2006 | ||||||||
LastUpdateDate: | 10/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | DUNN | ||||||||
AuthorizedOfficialFirstName: | RUTH | ||||||||
AuthorizedOfficialMiddleName: | L | ||||||||
AuthorizedOfficialTitleorPosition: | TREASURER | ||||||||
AuthorizedOfficialTelephone: | 5702265680 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |   |
No ID Information.