Provider Demographics
NPI:1629221064
Name:ORTHOPEDIC & SPORTS PHYSICAL THERAPY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:ORTHOPEDIC & SPORTS PHYSICAL THERAPY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:HENSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:724-483-3361
Mailing Address - Street 1:605 SCENERY DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:PA
Mailing Address - Zip Code:15037-2000
Mailing Address - Country:US
Mailing Address - Phone:412-751-0040
Mailing Address - Fax:412-751-0041
Practice Address - Street 1:605 SCENERY DR
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:PA
Practice Address - Zip Code:15037-2000
Practice Address - Country:US
Practice Address - Phone:412-751-0040
Practice Address - Fax:412-751-0041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment