MEDICARE: TOTAL CARE PHYSICAL THERAPY AND SPORTS PHYSICIANS LTD

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	208100000X	Physical Medicine & Rehabilitation Physician	MD032676Y	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
2	0640653000	OTHER	PA	HMO ID

General Provider Information

NPI Number	:	1992748172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL CARE PHYSICAL THERAPY AND SPORTS PHYSICIANS LTD

Provider Business Mailing Address
First Line	:	2637 E ALLEGHENY AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-5131
Country	:	US
Telephone Number	:	215-739-6780
Fax Number	:	215-739-6783

Provider Business Practice Location Address
First Line	:	2637 E ALLEGHENY AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-5131
Country	:	US
Telephone Number	:	215-739-6780
Fax Number	:	215-739-6783

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. ROBERT JOSEPH O'REILLY-GINDHART
Credential	:	M.D.
Telephone Number	:	215-739-6780

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	08/22/2020

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