Provider Demographics
NPI:1922020437
Name:ENDURANCE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:ENDURANCE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:TOURLITIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-497-9151
Mailing Address - Street 1:480 CONCHESTER HIGHWAY
Mailing Address - Street 2:SUITE 7 AND 8
Mailing Address - City:ASTON
Mailing Address - State:PA
Mailing Address - Zip Code:19014
Mailing Address - Country:US
Mailing Address - Phone:610-494-0412
Mailing Address - Fax:610-494-0424
Practice Address - Street 1:480 CONCHESTER HIGHWAY
Practice Address - Street 2:SUITE 7 AND 8
Practice Address - City:ASTON
Practice Address - State:PA
Practice Address - Zip Code:19014
Practice Address - Country:US
Practice Address - Phone:610-494-0412
Practice Address - Fax:610-494-0424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMI347643OtherHIGHMARK B/S
PA098902Medicare ID - Type Unspecified