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General NPI Number Information
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NPI Number | 1508115056
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Entity Type | Organization
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Legal Business Name | SPORTS AND BACK PT LLC
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Dates
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Enumeration Date | 08/30/2012
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Last Update Date | 08/30/2012
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Provider Practice Location Address
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Address Line | 370 E MAPLE AVE SUITE 103
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City | LANGHORNE
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State | PA
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Zip | 19047-2859
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Country | US
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Telephone | 215-752-4553
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Fax | 215-752-0703
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Provider Business Mailing Address
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Address Line | 370 E MAPLE AVE SUITE 103
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City | LANGHORNE
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State | PA
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Zip | 19047-2859
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Country | US
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Telephone | 215-752-4553
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Fax | 215-752-0703
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Authorized Official
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Title or Position | CEO
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Name | MRS. JACQUELINE M BORMAN
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Credential |
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Telephone | 215-752-4553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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