Provider Demographics
NPI:1578882502
Name:INNOVATIVE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:INNOVATIVE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT,
Authorized Official - Phone:610-344-7210
Mailing Address - Street 1:828 PAOLI PIKE
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4526
Mailing Address - Country:US
Mailing Address - Phone:610-344-7210
Mailing Address - Fax:610-344-7292
Practice Address - Street 1:828 PAOLI PIKE
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4526
Practice Address - Country:US
Practice Address - Phone:610-344-7210
Practice Address - Fax:610-344-7292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty