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NPI Code Detail

MEDICARE: PHYSICAL THERAPY AND WELLNESS INSTITUTE LLC

MEDICARE: PHYSICAL THERAPY AND WELLNESS INSTITUTE LLC
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
1225X00000XOccupational Therapist
2235Z00000XSpeech-Language Pathologist
3225100000XPhysical TherapistDAPT000285PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12078464000OTHERPAIBC KEYSTONE HMO
2001384752OTHERPAHIGHMARK BLUE SHIELD
37798359OTHERPAAETNA PPO

General Provider Information

NPI Number : 1740208339
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHYSICAL THERAPY AND WELLNESS INSTITUTE LLC
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 : 730 S BROAD ST
Second Line :
City : LANSDALE
State : PA
Zip : 19446-5211
Country : US
Telephone Number : 215-855-9871
Fax Number : 215-855-8748
Authorized Official
Title or Position : CEO
Name : MICHAEL RUCKER
Credential :
Telephone Number : 914-777-8700
Provider Enumeration Date : 07/18/2006
Last Update Date : 08/12/2022

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Directions to “PHYSICAL THERAPY AND WELLNESS INSTITUTE LLC ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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