Provider Demographics
NPI:1992037394
Name:MX PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:MX PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:MIERSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-322-5700
Mailing Address - Street 1:609 GOVERNOR SQ
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-3034
Mailing Address - Country:US
Mailing Address - Phone:302-836-5670
Mailing Address - Fax:
Practice Address - Street 1:609 GOVERNOR SQ
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-3034
Practice Address - Country:US
Practice Address - Phone:302-836-5670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE6176310003Medicare NSC