Provider Demographics
NPI:1033484621
Name:ADVANCED SPINE AND SPORTS THERAPY CENTER LLC
Entity Type:Organization
Organization Name:ADVANCED SPINE AND SPORTS THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DATIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-644-6902
Mailing Address - Street 1:266 LANCASTER AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-3256
Mailing Address - Country:US
Mailing Address - Phone:610-644-6900
Mailing Address - Fax:
Practice Address - Street 1:266 LANCASTER AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-3256
Practice Address - Country:US
Practice Address - Phone:610-644-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUGGIERO ORTHOPAEDIC ASSOCIATES, LTD, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty