Healthcare Provider Details

I. General information

NPI: 1972671352
Provider Name (Legal Business Name): SHIPPENSBURG PHYSICAL THERAPY AND SPORTS MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PARK PL SUITE 2
SHIPPENSBURG PA
17257-9806
US

IV. Provider business mailing address

20 PARK PL SUITE 2
SHIPPENSBURG PA
17257-9806
US

V. Phone/Fax

Practice location:
  • Phone: 717-477-8030
  • Fax: 717-477-8040
Mailing address:
  • Phone: 717-477-8030
  • Fax: 717-477-8040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT017913
License Number StatePA

VIII. Authorized Official

Name: DR. THOMAS EDWARD BLOUNT
Title or Position: PRESIDENT
Credential: DPT
Phone: 717-477-8030