Healthcare Provider Details

I. General information

NPI: 1972556835
Provider Name (Legal Business Name): BOUNCE BACK PHYSICAL THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 03/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 SUGARTOWN RD
WAYNE PA
19087-3004
US

IV. Provider business mailing address

215 SUGARTOWN RD
WAYNE PA
19087-3004
US

V. Phone/Fax

Practice location:
  • Phone: 484-582-0660
  • Fax: 484-582-0666
Mailing address:
  • Phone: 484-582-0660
  • Fax: 484-582-0666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. CHARAN TONY CHADHA
Title or Position: OWNER
Credential: MPT
Phone: 484-582-0660