Healthcare Provider Details

I. General information

NPI: 1356568687
Provider Name (Legal Business Name): LEMONT PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2766 W COLLEGE AVE SUITE 3
STATE COLLEGE PA
16801-2647
US

IV. Provider business mailing address

165 CENTENNIAL HILLS RD
PORT MATILDA PA
16870-8312
US

V. Phone/Fax

Practice location:
  • Phone: 814-861-6608
  • Fax: 814-861-6610
Mailing address:
  • Phone: 814-861-6608
  • Fax: 814-861-6610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT010739L
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier00719859
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK BLUE SHIELD
# 2
Identifier255448
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHEALTH AMERICA
# 3
Identifier255448
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHEALTH ASSURANCE
# 4
Identifier255448
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerADVANTRA
# 5
Identifier255448
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerCENTRAL PA TEAMSTERS
# 6
Identifier50044205
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerNCAS PENNSYLVANIA
# 7
Identifier255448
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerADVANTRA FREEDOM
# 8
Identifier50044205
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerCAPITAL BLUE CROSS
# 9
Identifier92766
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerGEISINGER HEALTH PLAN

VIII. Authorized Official

Name: AMY FLICK
Title or Position: OWNER-POSITION
Credential: PT, CLT
Phone: 814-861-6608