Provider Demographics
NPI:1437602554
Name:AGE WELL PHYSICAL THERAPY
Entity Type:Organization
Organization Name:AGE WELL PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:NAOMIE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, GCS
Authorized Official - Phone:215-313-4155
Mailing Address - Street 1:1956 LIMEKILN PIKE
Mailing Address - Street 2:
Mailing Address - City:DRESHER
Mailing Address - State:PA
Mailing Address - Zip Code:19025-1917
Mailing Address - Country:US
Mailing Address - Phone:215-313-4155
Mailing Address - Fax:215-914-6313
Practice Address - Street 1:1956 LIMEKILN PIKE
Practice Address - Street 2:
Practice Address - City:DRESHER
Practice Address - State:PA
Practice Address - Zip Code:19025-1917
Practice Address - Country:US
Practice Address - Phone:215-313-4155
Practice Address - Fax:215-914-6313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017291174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty