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
1	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	118100601	OTHER	PA	US DEPT OF LABOR
2	4566762	OTHER	PA	AETNA PPO GROUP #
3	0213003	OTHER	PA	ORTHONET
4	0444631000	OTHER	PA	BCBS HMO GROUP #
5	99493	OTHER	PA	AETNA HMO GROUP#
6	966448	OTHER	PA	BCBS PPO GROUP#

General Provider Information

NPI Number	:	1750331864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPEDIC AND SPORTS PHYSICAL THERAPY SERVICES, INC.

Provider Business Mailing Address
First Line	:	420 BAINBRIDGE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-1568
Country	:	US
Telephone Number	:	215-629-3837
Fax Number	:	215-629-5531

Provider Business Practice Location Address
First Line	:	1616 WALNUT ST
Second Line	:	SUITE 210
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-5313
Country	:	US
Telephone Number	:	215-545-8717
Fax Number	:	215-545-9355

Authorized Official
Title or Position	:	CEO
Name	:	JEFFREY ROBERT OSTROWSKI
Credential	:	PT
Telephone Number	:	215-629-3837

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	05/12/2008

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