Provider Demographics
NPI:1558477828
Name:CROSSROADS PHYSICAL THERAPY AND REHABILITATION, INC.
Entity Type:Organization
Organization Name:CROSSROADS PHYSICAL THERAPY AND REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:I
Authorized Official - Last Name:PARNELL
Authorized Official - Suffix:III
Authorized Official - Credentials:MSPT, ATC
Authorized Official - Phone:814-696-3400
Mailing Address - Street 1:1798 PLANK RD STE 103
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-8389
Mailing Address - Country:US
Mailing Address - Phone:814-696-3400
Mailing Address - Fax:814-696-3402
Practice Address - Street 1:1798 PLANK RD
Practice Address - Street 2:APT/STE 103
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-8341
Practice Address - Country:US
Practice Address - Phone:814-696-3400
Practice Address - Fax:814-696-3402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396797Medicare Oscar/Certification