Healthcare Provider Details

I. General information

NPI: 1114340072
Provider Name (Legal Business Name): POTTSTOWN MEMORIAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2014
Last Update Date: 12/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 ROBINSON ST
POTTSTOWN PA
19464-6439
US

IV. Provider business mailing address

81 ROBINSON ST
POTTSTOWN PA
19464-6439
US

V. Phone/Fax

Practice location:
  • Phone: 610-970-1600
  • Fax:
Mailing address:
  • Phone: 610-970-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT005383L
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DONNA WHITSELL
Title or Position: PROVIDER ENROLLMENT MANAGER
Credential:
Phone: 615-465-2877