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General NPI Number Information
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NPI Number | 1184152688
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Entity Type | Organization
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Legal Business Name | DEVELOPMENTAL FITNESS COMPANY
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Dates
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Enumeration Date | 05/27/2017
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Last Update Date | 12/29/2017
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Provider Practice Location Address
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Address Line | 609 W WALNUT ST
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City | NORTH WALES
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State | PA
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Zip | 19454-2613
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Country | US
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Telephone | 215-527-2475
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1025
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City | NORTH WALES
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State | PA
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Zip | 19454-0025
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Country | US
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Telephone | 215-527-2475
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Fax |
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Authorized Official
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Title or Position | FOUNDER, OWNER
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Name | DR. SEAN MICHAEL HANLEY
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Credential | DPT ATC
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Telephone | 215-527-2475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT023403
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License Number State | PA
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