Healthcare Provider Details

I. General information

NPI: 1265558373
Provider Name (Legal Business Name): STEVE K O PT, L.AC., CWS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 04/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1349 W CHELTENHAM AVE SUITE 201
ELKINS PARK PA
19027-3141
US

IV. Provider business mailing address

1349 W CHELTENHAM AVE SUITE 201
ELKINS PARK PA
19027-3141
US

V. Phone/Fax

Practice location:
  • Phone: 267-408-9294
  • Fax:
Mailing address:
  • Phone: 267-408-9294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT016630
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAK000999
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: