Provider Demographics
NPI:1780928267
Name:INSTRIDE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:INSTRIDE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:RICCI
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:484-472-6950
Mailing Address - Street 1:1402 INDUSTRIAL HIGHWAY
Mailing Address - Street 2:UNIT B
Mailing Address - City:EDDYSTONE
Mailing Address - State:PA
Mailing Address - Zip Code:19022-1522
Mailing Address - Country:US
Mailing Address - Phone:484-472-6950
Mailing Address - Fax:484-472-6948
Practice Address - Street 1:1402 INDUSTRIAL HIGHWAY
Practice Address - Street 2:UNIT B
Practice Address - City:EDDYSTONE
Practice Address - State:PA
Practice Address - Zip Code:19022-1522
Practice Address - Country:US
Practice Address - Phone:484-472-6950
Practice Address - Fax:484-472-6948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-21
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017599261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy