Provider Demographics
NPI:1689008328
Name:GRAND VIEW SPORTS MEDICINE CENTER
Entity Type:Organization
Organization Name:GRAND VIEW SPORTS MEDICINE CENTER
Other - Org Name:GRAND VIEW HOSPITAL SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VICE PRESIDENT/C.F.O.
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-453-4000
Mailing Address - Street 1:PO BOX 588
Mailing Address - Street 2:
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-0588
Mailing Address - Country:US
Mailing Address - Phone:215-453-4995
Mailing Address - Fax:215-453-4646
Practice Address - Street 1:915 LAWN AVE
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1551
Practice Address - Country:US
Practice Address - Phone:215-453-3270
Practice Address - Fax:215-453-3279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty