Provider Demographics
NPI: | 1013141134 |
---|---|
Name: | BRANDYWINE VALLEY CONSULTANTS, INC. |
Entity Type: | Organization |
Organization Name: | BRANDYWINE VALLEY CONSULTANTS, INC. |
Other - Org Name: | MAKING STRIDES |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | ROBIN |
Authorized Official - Middle Name: | L |
Authorized Official - Last Name: | LANGERHANS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DPT |
Authorized Official - Phone: | 610-656-8438 |
Mailing Address - Street 1: | 8137 LAKE MARGARET TER |
Mailing Address - Street 2: | |
Mailing Address - City: | CHESTERFIELD |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 23838-5559 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 610-656-8438 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 8137 LAKE MARGARET TER |
Practice Address - Street 2: | |
Practice Address - City: | CHESTERFIELD |
Practice Address - State: | VA |
Practice Address - Zip Code: | 23838 |
Practice Address - Country: | US |
Practice Address - Phone: | 610-656-8438 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-05-04 |
Last Update Date: | 2019-11-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QR0400X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation | Group - Multi-Specialty |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 226000000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Recreational Therapist Assistant | Group - Multi-Specialty | |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | LA574615 | Medicare UPIN |