Provider Demographics
NPI:1275134363
Name:TRINITY PHYSICAL THERAPY
Entity Type:Organization
Organization Name:TRINITY PHYSICAL THERAPY
Other - Org Name:MIR PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOWRY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, CFC
Authorized Official - Phone:570-575-5369
Mailing Address - Street 1:PO BOX 396
Mailing Address - Street 2:
Mailing Address - City:LEDERACH
Mailing Address - State:PA
Mailing Address - Zip Code:19450-0396
Mailing Address - Country:US
Mailing Address - Phone:215-256-1991
Mailing Address - Fax:215-256-1895
Practice Address - Street 1:703 HARLEYSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:LEDERACH
Practice Address - State:PA
Practice Address - Zip Code:19450
Practice Address - Country:US
Practice Address - Phone:215-256-1991
Practice Address - Fax:215-256-1895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-04
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy