MEDICARE: SOUTH PHILA PT ASSOC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1245230754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH PHILA PT ASSOC

Provider Business Mailing Address
First Line	:	1809 W OREGON AVE
Second Line	:	3RD FLOOR
City	:	PHILA
State	:	PA
Zip	:	19145-3710
Country	:	US
Telephone Number	:	215-467-1800
Fax Number	:	215-467-8120

Provider Business Practice Location Address
First Line	:	1809 W OREGON AVE
Second Line	:	3RD FLOOR
City	:	PHILA
State	:	PA
Zip	:	19145-3710
Country	:	US
Telephone Number	:	215-467-1800
Fax Number	:	215-467-8120

Authorized Official
Title or Position	:	VICE-PRESIDENT
Name	:	VINCENT P ESPOSITO
Credential	:	PT
Telephone Number	:	215-467-1800

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	08/22/2020

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Directions to “SOUTH PHILA PT ASSOC ” Practice Location

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