Healthcare Provider Details

I. General information

NPI: 1033399142
Provider Name (Legal Business Name): PROFESSIONAL SPORTS MEDICINE AND CHIROPRACITC CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 PENNS TRL
NEWTOWN PA
18940-1839
US

IV. Provider business mailing address

209 PENNS TRL
NEWTOWN PA
18940-1839
US

V. Phone/Fax

Practice location:
  • Phone: 215-579-2244
  • Fax:
Mailing address:
  • Phone: 215-579-2244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC004520-L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberADJ008969
License Number StatePA

VIII. Authorized Official

Name: DR. EILEEN LESTRANGE-SCHWARTZ
Title or Position: PRESIDENT
Credential: DC
Phone: 215-579-2244