Provider Demographics
NPI:1174921829
Name:ST. LUKE'S PHYSICAL THERAPY
Entity type:Organization
Organization Name:ST. LUKE'S PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-386-3399
Mailing Address - Street 1:2083 W PENN PIKE
Mailing Address - Street 2:
Mailing Address - City:ANDREAS
Mailing Address - State:PA
Mailing Address - Zip Code:18211-3259
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2083 W PENN PIKE
Practice Address - Street 2:
Practice Address - City:ANDREAS
Practice Address - State:PA
Practice Address - Zip Code:18211-3259
Practice Address - Country:US
Practice Address - Phone:570-386-3399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SLUHN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT12796L261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy