Provider Demographics
NPI:1417909664
Name:AMIT, OPHER (MPT)
Entity Type:Individual
Prefix:MR
First Name:OPHER
Middle Name:
Last Name:AMIT
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MARCUS HOOK
Mailing Address - State:PA
Mailing Address - Zip Code:19061-4513
Mailing Address - Country:US
Mailing Address - Phone:610-859-8850
Mailing Address - Fax:610-859-7876
Practice Address - Street 1:2966 STREET RD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-2604
Practice Address - Country:US
Practice Address - Phone:215-639-2639
Practice Address - Fax:215-929-2464
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015803225100000X
PADAPT001137225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101004983 0002Medicaid
PA30052899OtherKEYSTONE MERCY
PA2301064000OtherIBC
PA001624318OtherHIGHMARK BLUE SHIELD
PA101004983-0002Medicaid
PA2301064000OtherIBC
PA101004983-0002Medicaid