Provider Demographics
NPI:1639128846
Name:KEYSTONE ORTHOPEDIC PT, L.L.C.
Entity type:Organization
Organization Name:KEYSTONE ORTHOPEDIC PT, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, DPT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:BOBBY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, CSCS
Authorized Official - Phone:717-328-2121
Mailing Address - Street 1:123 N MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MERCERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17236-1723
Mailing Address - Country:US
Mailing Address - Phone:717-328-2121
Mailing Address - Fax:717-328-2127
Practice Address - Street 1:123 N MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MERCERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17236-1723
Practice Address - Country:US
Practice Address - Phone:717-328-2121
Practice Address - Fax:717-328-2127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012277L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty