MEDICARE: WHITE HORSE VILLAGE THERAPY 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
2	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1629917885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITE HORSE VILLAGE THERAPY LLC

Provider Business Mailing Address
First Line	:	535 GRADYVILLE ROAD
Second Line	:	OUTPATIENT SUITE
City	:	NEWTOWN SQUARE
State	:	PA
Zip	:	19073
Country	:	US
Telephone Number	:	610-558-5053
Fax Number	:

Provider Business Practice Location Address
First Line	:	535 GRADYVILLE ROAD
Second Line	:	OUTPATIENT SUITE
City	:	NEWTOWN SQUARE
State	:	PA
Zip	:	19073
Country	:	US
Telephone Number	:	610-558-5053
Fax Number	:

Authorized Official
Title or Position	:	VP OF FINANCE & IT
Name	:	NATHAN NILES
Credential	:	CPA
Telephone Number	:	610-558-5029

Provider Enumeration Date	:	03/25/2026
Last Update Date	:	04/24/2026

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