Provider Demographics
NPI:1811095631
Name:ORTHOPEDIC & SPINE PHYSICAL THERAPY
Entity type:Organization
Organization Name:ORTHOPEDIC & SPINE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HERSH
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHUKLA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:717-241-2211
Mailing Address - Street 1:850 WALNUT BOTTOM RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-3632
Mailing Address - Country:US
Mailing Address - Phone:717-241-2211
Mailing Address - Fax:717-241-2240
Practice Address - Street 1:850 WALNUT BOTTOM RD
Practice Address - Street 2:SUITE 306
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-3632
Practice Address - Country:US
Practice Address - Phone:717-241-2211
Practice Address - Fax:717-241-2240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA085800Medicare ID - Type Unspecified