Provider Demographics
NPI:1871635318
Name:THERAPHYSICAL CARE OF PENNSYLVANIA, LLC
Entity type:Organization
Organization Name:THERAPHYSICAL CARE OF PENNSYLVANIA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PT, PRESIDENT, PART OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARMEL
Authorized Official - Middle Name:DEL ROSARIO
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:215-227-2738
Mailing Address - Street 1:1919 CHESTNUT ST.
Mailing Address - Street 2:STE. 104
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-3456
Mailing Address - Country:US
Mailing Address - Phone:215-227-2738
Mailing Address - Fax:215-227-2739
Practice Address - Street 1:1919 CHESTNUT ST.
Practice Address - Street 2:STE. 104
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-3456
Practice Address - Country:US
Practice Address - Phone:215-227-2738
Practice Address - Fax:215-227-2739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT009930L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA111934Medicare PIN
PA114758WQNMedicare PIN
PA11959WQNMedicare PIN
PA114716WQNMedicare PIN