Provider Demographics
NPI:1720661127
Name:EISENHOFER PHYSICAL THERAPY
Entity Type:Organization
Organization Name:EISENHOFER PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:EISENHOFER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:484-408-4920
Mailing Address - Street 1:2459 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19605-9410
Mailing Address - Country:US
Mailing Address - Phone:304-488-5667
Mailing Address - Fax:
Practice Address - Street 1:1001 JAMES DR STE A14
Practice Address - Street 2:
Practice Address - City:LEESPORT
Practice Address - State:PA
Practice Address - Zip Code:19533-8867
Practice Address - Country:US
Practice Address - Phone:484-408-4920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy