Provider Demographics
NPI:1871354159
Name:MOTIVE SPORTS AND PHYSICAL THERAPY MALVERN, LLC
Entity type:Organization
Organization Name:MOTIVE SPORTS AND PHYSICAL THERAPY MALVERN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WORRILOW
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:610-500-5296
Mailing Address - Street 1:540 HOPEWELL ST
Mailing Address - Street 2:
Mailing Address - City:BIRDSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19508-2657
Mailing Address - Country:US
Mailing Address - Phone:610-500-5296
Mailing Address - Fax:484-359-0098
Practice Address - Street 1:480 LANCASTER AVE STE 4
Practice Address - Street 2:
Practice Address - City:FRAZER
Practice Address - State:PA
Practice Address - Zip Code:19355-1834
Practice Address - Country:US
Practice Address - Phone:610-500-5296
Practice Address - Fax:484-359-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty