Healthcare Provider Details

I. General information

NPI: 1003095324
Provider Name (Legal Business Name): PERSONAL TOUCH REHAB AND FITNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 JAMES WAY
SOUTHAMPTON PA
18966-3818
US

IV. Provider business mailing address

3538 ORIOLE DR
HUNTINGDON VALLEY PA
19006-3412
US

V. Phone/Fax

Practice location:
  • Phone: 215-635-5575
  • Fax: 215-635-5456
Mailing address:
  • Phone: 215-635-5575
  • Fax: 215-635-5456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberPT015515
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT015515
License Number StatePA

VIII. Authorized Official

Name: MS. MARIA BRODSKY
Title or Position: OFFICE MANAGER
Credential:
Phone: 215-635-5575