Provider Demographics
NPI:1184152688
Name:DEVELOPMENTAL FITNESS COMPANY
Entity type:Organization
Organization Name:DEVELOPMENTAL FITNESS COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT ATC
Authorized Official - Phone:215-527-2475
Mailing Address - Street 1:PO BOX 1025
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-0025
Mailing Address - Country:US
Mailing Address - Phone:215-527-2475
Mailing Address - Fax:
Practice Address - Street 1:609 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-2613
Practice Address - Country:US
Practice Address - Phone:215-527-2475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-27
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT023403225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty