=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447571328
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OSP, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2010
-----------------------------------------------------
Last Update Date | 01/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 801 EASTON RD STE 6
-----------------------------------------------------
City | WILLOW GROVE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19090-2024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-867-9677
-----------------------------------------------------
Fax | 215-839-3439
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 801 EASTON RD STE 6
-----------------------------------------------------
City | WILLOW GROVE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19090-2024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-867-9677
-----------------------------------------------------
Fax | 215-839-3439
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | DR. GLYNN C HUNT
-----------------------------------------------------
Credential | PT, DPT, MS
-----------------------------------------------------
Telephone | 215-867-9677
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------