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General NPI Number Information
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NPI Number | 1023420460
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Entity Type | Organization
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Legal Business Name | GARNET VALLEY SPORT & SPINE PHYSICAL MEDICINE, INC.
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Dates
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Enumeration Date | 05/20/2014
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Last Update Date | 05/20/2014
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Provider Practice Location Address
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Address Line | 3039 FOULK RD
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City | GARNET VALLEY
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State | PA
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Zip | 19060-1701
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Country | US
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Telephone | 610-361-0070
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Fax | 610-361-0071
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Provider Business Mailing Address
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Address Line | 3039 FOULK RD
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City | GARNET VALLEY
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State | PA
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Zip | 19060-1701
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Country | US
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Telephone | 610-361-0070
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Fax | 610-361-0071
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Authorized Official
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Title or Position | OWNER
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Name | DR. TIMOTHY MARTIN
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Credential | D.C.
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Telephone | 610-361-0070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | OS-008262-L
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License Number State | PA
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