=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932692654
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AIME INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2018
-----------------------------------------------------
Last Update Date | 06/07/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1448 WINDSOR PARK LN
-----------------------------------------------------
City | HAVERTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19083-2706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-517-6864
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1448 WINDSOR PARK LN
-----------------------------------------------------
City | HAVERTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19083-2706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-517-6864
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICAL THERAPIST
-----------------------------------------------------
Name | MRS. KATHLEN IRENE MELLEK
-----------------------------------------------------
Credential | MPT
-----------------------------------------------------
Telephone | 610-517-6864
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | PT015744
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------