Provider Demographics
NPI:1447424064
Name:ORTHOPEDIC AND SPORTS PHYSICAL THERAPY SERVICES, INC
Entity Type:Organization
Organization Name:ORTHOPEDIC AND SPORTS PHYSICAL THERAPY SERVICES, INC
Other - Org Name:EXCEL PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:OSTROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:215-629-3837
Mailing Address - Street 1:420 BAINBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1568
Mailing Address - Country:US
Mailing Address - Phone:215-629-3837
Mailing Address - Fax:
Practice Address - Street 1:9337 KREWSTOWN ROAD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115
Practice Address - Country:US
Practice Address - Phone:215-629-3837
Practice Address - Fax:215-629-5531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4566762OtherAETNA PPO
PA0099493OtherAETNA HMO
PA966448OtherBCBS PPO
PA044631000OtherIBC - PERSONAL CHOICE / KEYSTONE
PAA2590262OtherOXFORD
PA075361Medicare PIN