MEDICARE: GO THERAPY AND FITNESS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	PT012695L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1063410819	OTHER	PA	INDIVIDUAL OWNER'S NPI

General Provider Information

NPI Number	:	1215213723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GO THERAPY AND FITNESS, LLC

Provider Business Mailing Address
First Line	:	28 CRIMSON DR
Second Line	:
City	:	EAST NORRITON
State	:	PA
Zip	:	19401-1834
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	28 CRIMSON DR
Second Line	:
City	:	EAST NORRITON
State	:	PA
Zip	:	19401-1834
Country	:	US
Telephone Number	:	610-731-0129
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CHAD M SEEGERS
Credential	:	PHYSICAL THERAPIST
Telephone Number	:	610-731-0129

Provider Enumeration Date	:	10/27/2011
Last Update Date	:	10/27/2011

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Directions to “GO THERAPY AND FITNESS, LLC ” Practice Location

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