Provider Demographics
NPI:1033459615
Name:IMPACT PHYSIO
Entity Type:Organization
Organization Name:IMPACT PHYSIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SALVA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:570-319-6903
Mailing Address - Street 1:239 NORTHERN BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:SOUTH ABINGTON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18411-9302
Mailing Address - Country:US
Mailing Address - Phone:570-319-6903
Mailing Address - Fax:570-416-2807
Practice Address - Street 1:239 NORTHERN BLVD STE 5
Practice Address - Street 2:
Practice Address - City:SOUTH ABINGTON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18411-9302
Practice Address - Country:US
Practice Address - Phone:570-319-6903
Practice Address - Fax:570-416-2807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-19
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012829225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty