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General NPI Number Information
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NPI Number | 1639107071
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Entity Type | Organization
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Legal Business Name | AQUATIC THERAPY OF CHINATOWN
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 933 SPRING ST
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City | PHILADELPHIA
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State | PA
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Zip | 19107-1815
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Country | US
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Telephone | 215-574-9388
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Fax | 215-574-9188
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Provider Business Mailing Address
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Address Line | 7300 BRUCE DRIVE
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City | HOLLAND
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State | PA
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Zip | 18966
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Country | US
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Telephone | 215-703-3275
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPY/OWNER
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Name | LEONARD STAVROPOLSKIY
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Credential | MD
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Telephone | 215-574-9388
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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 | PT015799
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License Number State | PA
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