MEDICARE: ACTION POTENTIAL, 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	016638	PA

General Provider Information

NPI Number	:	1831478692
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTION POTENTIAL, LLC

Provider Business Mailing Address
First Line	:	1786 WILMINGTON W CHESTER PIKE STE 200A
Second Line	:
City	:	GLEN MILLS
State	:	PA
Zip	:	19342-8198
Country	:	US
Telephone Number	:	484-841-6154
Fax Number	:	484-841-6174

Provider Business Practice Location Address
First Line	:	1786 WILMINGTON W CHESTER PIKE STE 200A
Second Line	:
City	:	GLEN MILLS
State	:	PA
Zip	:	19342-8198
Country	:	US
Telephone Number	:	484-841-6154
Fax Number	:	484-841-6174

Authorized Official
Title or Position	:	CO-PRESIDENT
Name	:	KRISTEN ELIZABETH WILSON
Credential	:	DPT
Telephone Number	:	610-324-3073

Provider Enumeration Date	:	08/11/2011
Last Update Date	:	05/31/2024

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