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NPI Code Detail

MEDICARE: ORTHOPEDIC AND SPORTS PHYSICAL THERAPY SERVICES, INC.

MEDICARE: ORTHOPEDIC AND SPORTS PHYSICAL THERAPY SERVICES, INC.
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
1225100000XPhysical Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12020801OTHERNJHGHMARK BLUE SHIELD
2966448OTHERPABCBS PPO GROUP #
30099493OTHERPAAETNA HMO GROUP #
44566762OTHERPAAETNA PPO GROUP #
5A2590262OTHERPAOXFORD GROUP #
60444631000OTHERPAKEYSTONE GROUP #
7118100606OTHERUS DEPT. OF LABOR GRP #

General Provider Information

NPI Number : 1588661235
Entity Type Code : Organization
Provider Name (Legal Business Name) : ORTHOPEDIC AND SPORTS PHYSICAL THERAPY SERVICES, INC.
Provider Business Mailing Address
First Line : 1311 MAMARONECK AVE STE 140
Second Line :
City : WHITE PLAINS
State : NY
Zip : 10605-5224
Country : US
Telephone Number : 914-294-4050
Fax Number :
Provider Business Practice Location Address
First Line : 420 BAINBRIDGE ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19147-1568
Country : US
Telephone Number : 215-629-1270
Fax Number : 215-629-1293
Authorized Official
Title or Position : CEO
Name : MICHAEL RUCKER
Credential :
Telephone Number : 914-294-4050
Provider Enumeration Date : 07/07/2005
Last Update Date : 08/12/2022

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Directions to “ORTHOPEDIC AND SPORTS PHYSICAL THERAPY SERVICES, INC. ” Practice Location

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