Healthcare Provider Details

I. General information

NPI: 1457498446
Provider Name (Legal Business Name): MAKEFIELD PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 HEACOCK RD SUITE 200A
YARDLEY PA
19067-6346
US

IV. Provider business mailing address

680 HEACOCK RD SUITE 200A
YARDLEY PA
19067-6346
US

V. Phone/Fax

Practice location:
  • Phone: 215-321-6989
  • Fax: 215-321-7217
Mailing address:
  • Phone: 215-321-6989
  • Fax: 215-321-7217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT004069L
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier001583062
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerOTHER

VIII. Authorized Official

Name: MR. KENNETH T. RITCHIE
Title or Position: OWNER
Credential: PT
Phone: 215-321-6989