Provider Demographics
NPI:1043645948
Name:MAIN LINE HAND CENTER LLC
Entity Type:Organization
Organization Name:MAIN LINE HAND CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAMALA
Authorized Official - Middle Name:N
Authorized Official - Last Name:BONGIORNO
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:610-270-0370
Mailing Address - Street 1:120 W GERMANTOWN PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1420
Mailing Address - Country:US
Mailing Address - Phone:610-270-0370
Mailing Address - Fax:610-270-0374
Practice Address - Street 1:101 N MONROE ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3037
Practice Address - Country:US
Practice Address - Phone:484-444-0135
Practice Address - Fax:484-444-0138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0210802251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty