Provider Demographics
NPI:1639498835
Name:THERAPY SOURCE, INC.
Entity Type:Organization
Organization Name:THERAPY SOURCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTAGENOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:484-342-2000
Mailing Address - Street 1:5215 MILITIA HILL RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1276
Mailing Address - Country:US
Mailing Address - Phone:484-342-2000
Mailing Address - Fax:610-340-9122
Practice Address - Street 1:5215 MILITIA HILL RD
Practice Address - Street 2:SUITE A
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1276
Practice Address - Country:US
Practice Address - Phone:484-342-2000
Practice Address - Fax:610-340-9122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA10-0000015160251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services