Healthcare Provider Details

I. General information

NPI: 1467603720
Provider Name (Legal Business Name): PT HEALTHCARE PROVIDERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 10/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 FOX TAIL CT
NEW HOPE PA
18938-5775
US

IV. Provider business mailing address

718 FOX TAIL CT
NEW HOPE PA
18938-5775
US

V. Phone/Fax

Practice location:
  • Phone: 215-862-8135
  • Fax:
Mailing address:
  • Phone: 215-862-8135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ROBERT COBURN
Title or Position: PRINCIPLE
Credential:
Phone: 215-862-8135