Provider Demographics
NPI:1871132126
Name:SDI THERAPY, LLC
Entity type:Organization
Organization Name:SDI THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ILAN
Authorized Official - Middle Name:
Authorized Official - Last Name:IMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:561-809-1638
Mailing Address - Street 1:1610 IRON HORSE RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-7752
Mailing Address - Country:US
Mailing Address - Phone:561-809-1638
Mailing Address - Fax:
Practice Address - Street 1:319 W COUNTY LINE RD STE 9
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040-1605
Practice Address - Country:US
Practice Address - Phone:215-470-1652
Practice Address - Fax:610-471-0488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-04
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy