Provider Demographics
NPI:1497700710
Name:UPPER PERK PHYSICAL THERAPY & SPORTS REHAB., INC
Entity Type:Organization
Organization Name:UPPER PERK PHYSICAL THERAPY & SPORTS REHAB., INC
Other - Org Name:NEW HOPE PHYSICAL THERAPY & SPORTS REHAB., INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:KAUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:215-679-0105
Mailing Address - Street 1:2767 GERYVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:PENNSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18073-2306
Mailing Address - Country:US
Mailing Address - Phone:215-679-0105
Mailing Address - Fax:215-679-0722
Practice Address - Street 1:2767 GERYVILLE PIKE
Practice Address - Street 2:
Practice Address - City:PENNSBURG
Practice Address - State:PA
Practice Address - Zip Code:18073-2306
Practice Address - Country:US
Practice Address - Phone:215-679-0105
Practice Address - Fax:215-679-0722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006662L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5065681OtherAETNA NON-HMO
PA001542215OtherHIGHMARK/BLUE SHIELD
PA3325331OtherAETNA - HMO
PA2227091000OtherKEYSTONE HEALTH PLAN EAST
PA0017868690004Medicaid
PA30011373OtherKEYSTONE MERCY
PA2227091000OtherKEYSTONE HEALTH PLAN EAST