Healthcare Provider Details
I. General information
NPI: 1255012324
Provider Name (Legal Business Name): TUMMY TIME ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 07/31/2023
Last Update Date: 07/31/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1 NEUMANN DR
ASTON PA
19014
US
IV. Provider business mailing address
1200 E MAIN ST STE 2 #111
PALMYRA PA
17078-9517
US
V. Phone/Fax
- Phone: 717-710-6920
- Fax: 855-710-6454
- Phone: 717-710-6920
- Fax: 855-710-6454
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 225100000X |
| Taxonomy | Physical Therapist |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 225X00000X |
| Taxonomy | Occupational Therapist |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 235Z00000X |
| Taxonomy | Speech-Language Pathologist |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
TIMOTHY
ROSSNER
Title or Position: OWNER
Credential: PT, DPT
Phone: 717-710-6920