Healthcare Provider Details

I. General information

NPI: 1275599409
Provider Name (Legal Business Name): TRACY HORTER PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 CONESTOGA RD BLDG 3 STE 114
ROSEMONT PA
19010-1352
US

IV. Provider business mailing address

919 CONESTOGA RD BLDG 3 STE 114
ROSEMONT PA
19010-1352
US

V. Phone/Fax

Practice location:
  • Phone: 610-527-0178
  • Fax: 610-527-5770
Mailing address:
  • Phone: 610-527-0178
  • Fax: 610-527-5770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT002487L
License Number StatePA

VIII. Authorized Official

Name: MS. TRACY S HORTER
Title or Position: OWNER
Credential: PT
Phone: 610-527-0178