Provider Demographics
NPI:1588661235
Name:ORTHOPEDIC AND SPORTS PHYSICAL THERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:ORTHOPEDIC AND SPORTS PHYSICAL THERAPY SERVICES, INC.
Other - Org Name:EXCEL PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-294-4050
Mailing Address - Street 1:1311 MAMARONECK AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-5224
Mailing Address - Country:US
Mailing Address - Phone:914-294-4050
Mailing Address - Fax:
Practice Address - Street 1:420 BAINBRIDGE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-1568
Practice Address - Country:US
Practice Address - Phone:215-629-1270
Practice Address - Fax:215-629-1293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2020801OtherHGHMARK BLUE SHIELD
PA966448OtherBCBS PPO GROUP #
PA0099493OtherAETNA HMO GROUP #
PA4566762OtherAETNA PPO GROUP #
PAA2590262OtherOXFORD GROUP #
PA0444631000OtherKEYSTONE GROUP #
118100606OtherUS DEPT. OF LABOR GRP #
PA0444631000OtherKEYSTONE GROUP #
NJ082277Medicare ID - Type UnspecifiedMEDICARE GROUP #