Provider Demographics
NPI:1750616728
Name:CORE PHYSICAL THEARPY & REHABILITATION LLC
Entity type:Organization
Organization Name:CORE PHYSICAL THEARPY & REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:PADAMONSKY
Authorized Official - Suffix:II
Authorized Official - Credentials:MPT
Authorized Official - Phone:814-937-7073
Mailing Address - Street 1:108 ALDRICH AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-3202
Mailing Address - Country:US
Mailing Address - Phone:814-937-7073
Mailing Address - Fax:
Practice Address - Street 1:5410 6TH AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-1203
Practice Address - Country:US
Practice Address - Phone:814-937-7073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018015261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy