Provider Demographics
NPI:1275513954
Name:ORTHOPAEDIC & SPORTS PHYSIOTHERAPY P.A.
Entity Type:Organization
Organization Name:ORTHOPAEDIC & SPORTS PHYSIOTHERAPY P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NALINI
Authorized Official - Middle Name:MOHAN
Authorized Official - Last Name:ADVANI
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:302-683-0782
Mailing Address - Street 1:617 W NEWPORT PIKE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19804-3235
Mailing Address - Country:US
Mailing Address - Phone:302-683-0782
Mailing Address - Fax:302-683-0783
Practice Address - Street 1:617 W NEWPORT PIKE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19804-3235
Practice Address - Country:US
Practice Address - Phone:302-683-0782
Practice Address - Fax:302-683-0783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0001227225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEP00051339Medicare ID - Type UnspecifiedMEDICARE RAILROAD CARRIER
491552Medicare ID - Type Unspecified