MEDICARE: LA FORTALEZA PHYSICAL THERAPY 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
1	225X00000X	Occupational Therapist	PT-009127L	PA
2	225100000X	Physical Therapist	PT-009127L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609170679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LA FORTALEZA PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	133 W HUNTING PARK AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-2717
Country	:	US
Telephone Number	:	215-455-5370
Fax Number	:	215-427-2433

Provider Business Practice Location Address
First Line	:	3251 CEDAR ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-4514
Country	:	US
Telephone Number	:	215-427-2242
Fax Number	:	215-427-2433

Authorized Official
Title or Position	:	DIRECTOR
Name	:	LUIS HINCAPIE
Credential	:	MPT
Telephone Number	:	215-778-3988

Provider Enumeration Date	:	01/05/2011
Last Update Date	:	07/16/2019

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