Provider Demographics
NPI:1851414205
Name:ORTHO SPORT REHABILITATION
Entity Type:Organization
Organization Name:ORTHO SPORT REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:SHENKO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:215-269-6113
Mailing Address - Street 1:PO BOX 26836
Mailing Address - Street 2:
Mailing Address - City:TRAPPE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-0836
Mailing Address - Country:US
Mailing Address - Phone:215-269-6113
Mailing Address - Fax:215-269-6115
Practice Address - Street 1:5 HAZELWOOD CIR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1039
Practice Address - Country:US
Practice Address - Phone:610-825-3989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006125L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty