Provider Demographics
NPI: | 1013548379 |
---|---|
Name: | SPECIALTY PHYSICAL THERAPY LLC |
Entity Type: | Organization |
Organization Name: | SPECIALTY PHYSICAL THERAPY LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KIMBERLY |
Authorized Official - Middle Name: | W |
Authorized Official - Last Name: | CARPENTER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DPT |
Authorized Official - Phone: | 570-991-1530 |
Mailing Address - Street 1: | 1062 WYOMING AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | WYOMING |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 18644-1331 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 570-991-1530 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1062 WYOMING AVE |
Practice Address - Street 2: | |
Practice Address - City: | WYOMING |
Practice Address - State: | PA |
Practice Address - Zip Code: | 18644-1331 |
Practice Address - Country: | US |
Practice Address - Phone: | 570-991-1530 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-01-27 |
Last Update Date: | 2020-01-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Multi-Specialty | |
No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
No | 2255A2300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer | Group - Multi-Specialty |
No | 225700000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty |