Healthcare Provider Details

I. General information

NPI: 1780928267
Provider Name (Legal Business Name): INSTRIDE PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2012
Last Update Date: 01/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 INDUSTRIAL HIGHWAY UNIT B
EDDYSTONE PA
19022-1522
US

IV. Provider business mailing address

1402 INDUSTRIAL HIGHWAY UNIT B
EDDYSTONE PA
19022-1522
US

V. Phone/Fax

Practice location:
  • Phone: 484-472-6950
  • Fax: 484-472-6948
Mailing address:
  • Phone: 484-472-6950
  • Fax: 484-472-6948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT017599
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. JOSEPH JOHN RICCI
Title or Position: CEO
Credential: MPT
Phone: 484-472-6950