Provider Demographics
NPI:1144424508
Name:DELAWARE VALLEY SPORTS & SPINAL PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:DELAWARE VALLEY SPORTS & SPINAL PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, MTC
Authorized Official - Phone:215-357-0505
Mailing Address - Street 1:PO BOX 1081
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-0781
Mailing Address - Country:US
Mailing Address - Phone:215-357-0505
Mailing Address - Fax:215-357-0808
Practice Address - Street 1:1201 BUSTLETON PIKE
Practice Address - Street 2:SUITE 201
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:19053
Practice Address - Country:US
Practice Address - Phone:215-357-0808
Practice Address - Fax:215-357-0808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-008023-L2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty