Provider Demographics
NPI: | 1811434335 |
---|---|
Name: | CHRISTIAN RADZINSKI DPT PC |
Entity type: | Organization |
Organization Name: | CHRISTIAN RADZINSKI DPT PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DOCTOR OF PHYSICAL THERAPY / OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | CHRISTIAN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | RADZINSKI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DPT |
Authorized Official - Phone: | 267-210-4114 |
Mailing Address - Street 1: | 586 WEBSTER AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | LANGHORNE |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 19047-7535 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 267-210-4114 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 808 N BROAD ST |
Practice Address - Street 2: | |
Practice Address - City: | PHILADELPHIA |
Practice Address - State: | PA |
Practice Address - Zip Code: | 19130-2235 |
Practice Address - Country: | US |
Practice Address - Phone: | 215-236-1010 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-01-22 |
Last Update Date: | 2017-01-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | 024495 | 261QP2000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |