Provider Demographics
NPI:1285848184
Name:SPECTRUM THERAPY LLC
Entity Type:Organization
Organization Name:SPECTRUM THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURI
Authorized Official - Middle Name:F
Authorized Official - Last Name:BULKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-553-1633
Mailing Address - Street 1:RR 1 BOX 1836
Mailing Address - Street 2:STANLEY LAKE ROAD
Mailing Address - City:FRIENDSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18818-9620
Mailing Address - Country:US
Mailing Address - Phone:570-553-1633
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 1836
Practice Address - Street 2:STANLEY LAKE ROAD
Practice Address - City:FRIENDSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18818-9620
Practice Address - Country:US
Practice Address - Phone:570-553-1633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012634L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty