Provider Demographics
NPI:1245273127
Name:SPORTS AND BACK REHABILITATION INC
Entity type:Organization
Organization Name:SPORTS AND BACK REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:215-752-4553
Mailing Address - Street 1:370 E MAPLE AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-2859
Mailing Address - Country:US
Mailing Address - Phone:215-752-4553
Mailing Address - Fax:215-752-0703
Practice Address - Street 1:370 E MAPLE AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-2859
Practice Address - Country:US
Practice Address - Phone:215-752-4553
Practice Address - Fax:215-752-0703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0053616OtherAETNA
PA0423943000OtherINDEPENDENCE BLUE CROSS
PA0053616OtherAETNA