Provider Demographics
NPI:1467859405
Name:CENTRAL PENN IN HOME THERAPY
Entity Type:Organization
Organization Name:CENTRAL PENN IN HOME THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SOPHEAP
Authorized Official - Middle Name:
Authorized Official - Last Name:YI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:717-926-6677
Mailing Address - Street 1:520 HEDGE ROW LN
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:PA
Mailing Address - Zip Code:17078-8651
Mailing Address - Country:US
Mailing Address - Phone:717-926-6677
Mailing Address - Fax:717-838-4581
Practice Address - Street 1:609 N 12TH ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17046-3381
Practice Address - Country:US
Practice Address - Phone:717-926-6677
Practice Address - Fax:717-838-4581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015630261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy