Provider Demographics
NPI:1245230754
Name:SOUTH PHILA PT ASSOC
Entity Type:Organization
Organization Name:SOUTH PHILA PT ASSOC
Other - Org Name:PENNSPORT WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:P
Authorized Official - Last Name:ESPOSITO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:215-467-1800
Mailing Address - Street 1:1809 W OREGON AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-3710
Mailing Address - Country:US
Mailing Address - Phone:215-467-1800
Mailing Address - Fax:215-467-8120
Practice Address - Street 1:1809 W OREGON AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19145-3710
Practice Address - Country:US
Practice Address - Phone:215-467-1800
Practice Address - Fax:215-467-8120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA818836Medicare ID - Type Unspecified