Healthcare Provider Details

I. General information

NPI: 1518360890
Provider Name (Legal Business Name): CB PEDIATRIC PHYSICAL THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 CREEKVIEW DR
OREFIELD PA
18069-2271
US

IV. Provider business mailing address

5255 CREEKVIEW DR
OREFIELD PA
18069-2271
US

V. Phone/Fax

Practice location:
  • Phone: 610-704-4231
  • Fax:
Mailing address:
  • Phone: 610-704-4231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: CHRISTINE S BERGER
Title or Position: SOLE MEMBER
Credential:
Phone: 610-704-4231