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General NPI Number Information
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NPI Number | 1487885554
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Entity Type | Organization
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Legal Business Name | IMPACT PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 08/06/2009
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Last Update Date | 09/18/2014
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Provider Practice Location Address
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Address Line | 5415 W LAKE RD
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City | ERIE
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State | PA
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Zip | 16505-2841
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Country | US
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Telephone | 814-838-2133
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Fax | 814-838-2355
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Provider Business Mailing Address
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Address Line | 5415 W LAKE RD
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City | ERIE
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State | PA
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Zip | 16505-2841
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Country | US
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Telephone | 814-838-2133
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Fax | 814-838-2355
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Authorized Official
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Title or Position | OWNER
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Name | CURTIS CARDMAN
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Credential | MPT
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Telephone | 814-881-9193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PT006544L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PT008392L
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License Number State | PA
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