Provider Demographics
NPI:1760958441
Name:FUNCTIONAL PERFORMANCE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:FUNCTIONAL PERFORMANCE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:SEO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:610-822-1072
Mailing Address - Street 1:100 CHETWYND DR STE 103
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1453
Mailing Address - Country:US
Mailing Address - Phone:610-822-1072
Mailing Address - Fax:
Practice Address - Street 1:100 CHETWYND DR STE 103
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1453
Practice Address - Country:US
Practice Address - Phone:610-822-1072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-19
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy