Provider Demographics
NPI:1285673517
Name:LA FORTALEZA PHYSICAL THERAPY CENTER INC.
Entity Type:Organization
Organization Name:LA FORTALEZA PHYSICAL THERAPY CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:HINCAPIE
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:215-455-5370
Mailing Address - Street 1:133 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-2717
Mailing Address - Country:US
Mailing Address - Phone:215-455-5370
Mailing Address - Fax:215-455-5374
Practice Address - Street 1:133 W HUNTING PARK AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-2717
Practice Address - Country:US
Practice Address - Phone:215-455-5370
Practice Address - Fax:215-455-5374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-009127L225100000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017400900003Medicaid
PA0017400900003Medicaid