MEDICARE: INSTRIDE PHYSICAL THERAPY 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
1	261QP2000X	Physical Therapy Clinic/Center	PT017599	PA

General Provider Information

NPI Number	:	1780928267
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSTRIDE PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	1402 INDUSTRIAL HIGHWAY
Second Line	:	UNIT B
City	:	EDDYSTONE
State	:	PA
Zip	:	19022-1522
Country	:	US
Telephone Number	:	484-472-6950
Fax Number	:	484-472-6948

Provider Business Practice Location Address
First Line	:	1402 INDUSTRIAL HIGHWAY
Second Line	:	UNIT B
City	:	EDDYSTONE
State	:	PA
Zip	:	19022-1522
Country	:	US
Telephone Number	:	484-472-6950
Fax Number	:	484-472-6948

Authorized Official
Title or Position	:	CEO
Name	:	MR. JOSEPH JOHN RICCI
Credential	:	MPT
Telephone Number	:	484-472-6950

Provider Enumeration Date	:	11/21/2012
Last Update Date	:	01/10/2018

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Directions to “INSTRIDE PHYSICAL THERAPY LLC ” Practice Location

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