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General NPI Number Information
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NPI Number | 1740208339
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY AND WELLNESS INSTITUTE LLC
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 08/12/2022
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Provider Practice Location Address
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Address Line | 730 S BROAD ST
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City | LANSDALE
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State | PA
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Zip | 19446-5211
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Country | US
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Telephone | 215-855-9871
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Fax | 215-855-8748
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Provider Business Mailing Address
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Address Line | 1311 MAMARONECK AVE STE 140
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City | WHITE PLAINS
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State | NY
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Zip | 10605-5224
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Country | US
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Telephone | 914-294-4050
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MICHAEL RUCKER
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Credential |
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Telephone | 914-777-8700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | DAPT000285
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License Number State | PA
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