Provider Demographics
NPI:1063429637
Name:LIFE FITNESS PHYSICAL THERAPY OF
Entity type:Organization
Organization Name:LIFE FITNESS PHYSICAL THERAPY OF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:MELIN
Authorized Official - Last Name:TELEMECO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-597-5558
Mailing Address - Street 1:11368 WILLIAMSPORT PIKE
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:17225-8465
Mailing Address - Country:US
Mailing Address - Phone:717-597-5558
Mailing Address - Fax:717-597-5513
Practice Address - Street 1:11368 WILLIAMSPORT PIKE
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:PA
Practice Address - Zip Code:17225-8465
Practice Address - Country:US
Practice Address - Phone:717-597-5558
Practice Address - Fax:717-597-5513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA079507Medicare PIN
PAY11014Medicare UPIN