Provider Demographics
NPI:1063748762
Name:LEG UP FARM, INC.
Entity type:Organization
Organization Name:LEG UP FARM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTRIOTA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:717-266-9294
Mailing Address - Street 1:4880 N SHERMAN STREET EXT
Mailing Address - Street 2:
Mailing Address - City:MOUNT WOLF
Mailing Address - State:PA
Mailing Address - Zip Code:17347-9637
Mailing Address - Country:US
Mailing Address - Phone:717-266-9294
Mailing Address - Fax:717-384-8071
Practice Address - Street 1:4880 N SHERMAN STREET EXT
Practice Address - Street 2:
Practice Address - City:MOUNT WOLF
Practice Address - State:PA
Practice Address - Zip Code:17347-9637
Practice Address - Country:US
Practice Address - Phone:717-266-9294
Practice Address - Fax:717-384-8071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-30
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
221700000X, 224Z00000X, 225100000X, 225200000X, 225A00000X, 235Z00000X, 225X00000X
PA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023981110001Medicaid