Provider Demographics
NPI:1891489605
Name:CHRONIC PAIN PHYSICAL THERAPY
Entity Type:Organization
Organization Name:CHRONIC PAIN PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NOAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KUBISSA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:315-398-9813
Mailing Address - Street 1:1225 YARDLEY RD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-7401
Mailing Address - Country:US
Mailing Address - Phone:315-398-9813
Mailing Address - Fax:
Practice Address - Street 1:1225 YARDLEY RD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-7401
Practice Address - Country:US
Practice Address - Phone:315-398-9813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy