Provider Demographics
NPI:1417093634
Name:RIVERSIDE PHYSICAL THERAPY, LTD.
Entity Type:Organization
Organization Name:RIVERSIDE PHYSICAL THERAPY, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:TOMASETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:215-781-6973
Mailing Address - Street 1:231 MILL ST
Mailing Address - Street 2:P.O. BOX 569
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-4808
Mailing Address - Country:US
Mailing Address - Phone:215-781-6973
Mailing Address - Fax:215-781-6974
Practice Address - Street 1:231 MILL ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-4808
Practice Address - Country:US
Practice Address - Phone:215-781-6973
Practice Address - Fax:215-781-6974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2037936000OtherIBC HMO ID
PA001339049OtherBLUE SHIELD ID
PA001339049OtherBLUE SHIELD ID