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General NPI Number Information
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NPI Number | 1962018440
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Entity Type | Organization
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Legal Business Name | FUNCTIONAL PHYSICAL THERAPY LLC.
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Dates
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Enumeration Date | 09/19/2020
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Last Update Date | 09/19/2020
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Provider Practice Location Address
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Address Line | 1900 JOHN F KENNEDY BLVD
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City | PHILADELPHIA
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State | PA
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Zip | 19103-1440
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Country | US
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Telephone | 267-918-7122
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Fax |
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Provider Business Mailing Address
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Address Line | 38 NAROTHYN RD
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City | SELLERSVILLE
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State | PA
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Zip | 18960-2957
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Country | US
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Telephone | 267-918-7122
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DANIEL BENJAMIN VIZAK
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Credential | DPT.
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Telephone | 267-918-7122
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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 |
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License Number State |
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