Provider Demographics
NPI:1609477439
Name:INSTITUTE OF PHYSICAL THERAPY AND PELVIC HEALTH INC
Entity Type:Organization
Organization Name:INSTITUTE OF PHYSICAL THERAPY AND PELVIC HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, DIRECTOR, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SERENA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, NCS
Authorized Official - Phone:215-530-2128
Mailing Address - Street 1:4220 WILKIE WAY
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-4430
Mailing Address - Country:US
Mailing Address - Phone:215-530-2128
Mailing Address - Fax:
Practice Address - Street 1:425 PORTAGE AVE STE A
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-2213
Practice Address - Country:US
Practice Address - Phone:650-935-4711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy