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NPI Code Detail

MEDICARE: ORTHOPEDIC AND SPORTS PHYSICAL THERAPY SERVICES, INC.

MEDICARE: ORTHOPEDIC AND SPORTS PHYSICAL THERAPY SERVICES, INC.
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
1225100000XPhysical Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10213007OTHERPAORTHONET
20444631000OTHERPABCBS HMO GROUP#
3966448OTHERPABCBS PPO GROUP #
4118100602OTHERPAUS DEPT OF LABOR
599493OTHERPAAETNA HMO GROUP#
64566762OTHERPAAETNA PPO GROUP#

General Provider Information

NPI Number : 1992755698
Entity Type Code : Organization
Provider Name (Legal Business Name) : ORTHOPEDIC AND SPORTS PHYSICAL THERAPY SERVICES, INC.
Provider Business Mailing Address
First Line : 420 BAINBRIDGE ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19147-1568
Country : US
Telephone Number : 215-629-3837
Fax Number : 215-629-5531
Provider Business Practice Location Address
First Line : 9389 KREWSTOWN RD
Second Line : NORTHEAST RACQUET CLUB & FITNESS CENTER
City : PHILADELPHIA
State : PA
Zip : 19115-3710
Country : US
Telephone Number : 215-676-6760
Fax Number : 215-676-3746
Authorized Official
Title or Position : CEO
Name : JEFFREY ROBERT OSTROWSKI
Credential : PT
Telephone Number : 215-629-3837
Provider Enumeration Date : 05/11/2006
Last Update Date : 05/12/2008

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