Provider Demographics
NPI:1437180460
Name:NORTHWESTERN PHYSICAL THERAPY AND FITNESS, INC.
Entity Type:Organization
Organization Name:NORTHWESTERN PHYSICAL THERAPY AND FITNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:SMURDA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:610-767-8480
Mailing Address - Street 1:6305 ROUTE 309
Mailing Address - Street 2:
Mailing Address - City:NEW TRIPOLI
Mailing Address - State:PA
Mailing Address - Zip Code:18066-2000
Mailing Address - Country:US
Mailing Address - Phone:610-767-8480
Mailing Address - Fax:610-767-8487
Practice Address - Street 1:6299 ROUTE 309
Practice Address - Street 2:SUITE 305
Practice Address - City:NEW TRIPOLI
Practice Address - State:PA
Practice Address - Zip Code:18066-2000
Practice Address - Country:US
Practice Address - Phone:610-767-8480
Practice Address - Fax:610-767-8487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA087294Medicare ID - Type Unspecified