Provider Demographics
NPI:1689743098
Name:VITAL LINK PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:VITAL LINK PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:215-794-1944
Mailing Address - Street 1:PO BOX 411
Mailing Address - Street 2:
Mailing Address - City:FURLONG
Mailing Address - State:PA
Mailing Address - Zip Code:18925-0411
Mailing Address - Country:US
Mailing Address - Phone:215-794-9144
Mailing Address - Fax:215-794-1944
Practice Address - Street 1:3488 YORK RD
Practice Address - Street 2:
Practice Address - City:FURLONG
Practice Address - State:PA
Practice Address - Zip Code:18925-1227
Practice Address - Country:US
Practice Address - Phone:215-794-1944
Practice Address - Fax:215-794-1944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA070170Medicare ID - Type UnspecifiedPHYSICAL THERAPY