Provider Demographics
NPI:1568419521
Name:JGS PHYSICAL THERAPIST INC.
Entity Type:Organization
Organization Name:JGS PHYSICAL THERAPIST INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SACCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-664-3268
Mailing Address - Street 1:59 ROCKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1836
Mailing Address - Country:US
Mailing Address - Phone:610-664-3268
Mailing Address - Fax:
Practice Address - Street 1:59 ROCKLAND AVE
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1836
Practice Address - Country:US
Practice Address - Phone:610-664-3268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007341L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA056923Medicare ID - Type Unspecified