Healthcare Provider Details

I. General information

NPI: 1932374113
Provider Name (Legal Business Name): SOUTH MOUNTAIN PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4740 PENN AVE
SINKING SPRING PA
19608-9672
US

IV. Provider business mailing address

4740 PENN AVE
SINKING SPRING PA
19608-9672
US

V. Phone/Fax

Practice location:
  • Phone: 610-927-5183
  • Fax: 610-927-6994
Mailing address:
  • Phone: 610-927-5183
  • Fax: 610-927-6994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT010933L
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: KAI H. PEDERSEN
Title or Position: OWNER
Credential: PT
Phone: 610-927-5183