Provider Demographics
NPI:1245424522
Name:JOINT & SPINE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:JOINT & SPINE PHYSICAL THERAPY
Other - Org Name:JOINT & SPINE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZACKROFF
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:610-353-7533
Mailing Address - Street 1:4647 WEST CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-2226
Mailing Address - Country:US
Mailing Address - Phone:610-353-7533
Mailing Address - Fax:610-353-7535
Practice Address - Street 1:747 W CYPRESS ST
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-2463
Practice Address - Country:US
Practice Address - Phone:610-353-7533
Practice Address - Fax:610-353-7535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012940L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA087813Medicare PIN