Provider Demographics
NPI:1609170679
Name:LA FORTALEZA PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:LA FORTALEZA PHYSICAL THERAPY INC
Other - Org Name:LA FORTALEZA OCCUPATIONAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HINCAPIE
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:215-778-3988
Mailing Address - Street 1:133 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-2717
Mailing Address - Country:US
Mailing Address - Phone:215-455-5370
Mailing Address - Fax:215-427-2433
Practice Address - Street 1:3251 CEDAR ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4514
Practice Address - Country:US
Practice Address - Phone:215-427-2242
Practice Address - Fax:215-427-2433
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LA FORTALEZA PHYSICAL THERAPY CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-05
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-009127L225100000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017400900003Medicaid
PA194723Medicare PIN