Provider Demographics
NPI:1720365489
Name:COMMONHEALTH ORTHOPEDIC PHYSICAL THERAPY
Entity Type:Organization
Organization Name:COMMONHEALTH ORTHOPEDIC PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:CREZNIC
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:717-585-0510
Mailing Address - Street 1:7700 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-3857
Mailing Address - Country:US
Mailing Address - Phone:717-585-0510
Mailing Address - Fax:
Practice Address - Street 1:337 W KING ST
Practice Address - Street 2:
Practice Address - City:EAST BERLIN
Practice Address - State:PA
Practice Address - Zip Code:17316-9730
Practice Address - Country:US
Practice Address - Phone:717-585-0510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018772261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy