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General NPI Number Information
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NPI Number | 1083659783
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Entity Type | Organization
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Legal Business Name | WILLOW GROVE PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 2325 MARYLAND ROAD SUITE 205
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City | WILLOW GROVE
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State | PA
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Zip | 19090
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Country | US
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Telephone | 215-659-7759
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Fax | 215-659-6658
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Provider Business Mailing Address
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Address Line | PO BOX 52408
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City | PHOENIX
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State | AZ
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Zip | 85072-2408
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Country | US
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Telephone | 215-659-7759
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Fax | 215-659-6658
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | ANNA GAYLORD
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Credential |
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Telephone | 678-837-7176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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