Provider Demographics
NPI:1558465682
Name:VSPORTS REHABILITATION, LLC
Entity Type:Organization
Organization Name:VSPORTS REHABILITATION, LLC
Other - Org Name:VELOCITY SPORTS REHABILITATION, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCROSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-674-3373
Mailing Address - Street 1:PO BOX 8500
Mailing Address - Street 2:LOCKBOX #4446
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-8500
Mailing Address - Country:US
Mailing Address - Phone:888-846-5527
Mailing Address - Fax:607-324-2369
Practice Address - Street 1:700 VETERANS CIR
Practice Address - Street 2:SUITE 200
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-3532
Practice Address - Country:US
Practice Address - Phone:215-674-3373
Practice Address - Fax:215-674-3736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1545-0003261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30031829OtherKEYSTONE MERCY GROUP #
PA833387UG6Medicare PIN