Provider Demographics
NPI:1598240384
Name:PETROSKI PHYSIOTHERAPY AND PERFORMANCE LLC
Entity Type:Organization
Organization Name:PETROSKI PHYSIOTHERAPY AND PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PETROSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:215-776-4872
Mailing Address - Street 1:12285 MCNULTY RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-1210
Mailing Address - Country:US
Mailing Address - Phone:215-776-4872
Mailing Address - Fax:
Practice Address - Street 1:12285 MCNULTY RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-1210
Practice Address - Country:US
Practice Address - Phone:215-776-4872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-27
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1871011882OtherN/A