Healthcare Provider Details

I. General information

NPI: 1962721480
Provider Name (Legal Business Name): PREMIER ORTHOPAEDIC AND SPORTS MEDICINE ASSOCIATES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2010
Last Update Date: 11/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 EVERGREEN DR STE 220
GLEN MILLS PA
19342-1059
US

IV. Provider business mailing address

300 EVERGREEN DR STE 220
GLEN MILLS PA
19342-1059
US

V. Phone/Fax

Practice location:
  • Phone: 610-579-3650
  • Fax:
Mailing address:
  • Phone: 610-579-3650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: KIM STOTT
Title or Position: ADMINISTRATIVE MANAGER
Credential:
Phone: 610-359-5664