Provider Demographics
NPI:1336110923
Name:THOMAS E MACKELL MD LTD
Entity Type:Organization
Organization Name:THOMAS E MACKELL MD LTD
Other - Org Name:FITNESS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:MACKELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-348-3068
Mailing Address - Street 1:800 W STATE ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-5842
Mailing Address - Country:US
Mailing Address - Phone:215-348-3068
Mailing Address - Fax:215-348-7428
Practice Address - Street 1:847 EASTON RD
Practice Address - Street 2:SUITE 2750
Practice Address - City:WARRINGTON
Practice Address - State:PA
Practice Address - Zip Code:18976
Practice Address - Country:US
Practice Address - Phone:215-918-5600
Practice Address - Fax:215-918-5603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2008-11-04
Deactivation Date:2008-08-01
Deactivation Code:
Reactivation Date:2008-11-03
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA111202OtherBLUE SHIELD
PA111202OtherBLUE SHIELD