Provider Demographics
NPI:1881290716
Name:SENIOR FIT PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:SENIOR FIT PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MUDGETT- MCGEOCH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:484-667-8295
Mailing Address - Street 1:23 DUTTON FARM LN
Mailing Address - Street 2:
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-9473
Mailing Address - Country:US
Mailing Address - Phone:484-667-8295
Mailing Address - Fax:484-727-4866
Practice Address - Street 1:206 N JENNERSVILLE RD STE 100
Practice Address - Street 2:
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9326
Practice Address - Country:US
Practice Address - Phone:610-869-6833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-07
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty