Provider Demographics
NPI:1104880590
Name:PENN THERAPY ASSOCIATES, INC.
Entity type:Organization
Organization Name:PENN THERAPY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:REITZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:610-853-0508
Mailing Address - Street 1:2010 W CHESTER PIKE
Mailing Address - Street 2:SUITE 450
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-2700
Mailing Address - Country:US
Mailing Address - Phone:610-853-0508
Mailing Address - Fax:610-853-3837
Practice Address - Street 1:2010 W CHESTER PIKE
Practice Address - Street 2:SUITE 450
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-2700
Practice Address - Country:US
Practice Address - Phone:610-853-0508
Practice Address - Fax:610-853-3837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT003694L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0775764000OtherIBC GROUP #
PAPE844978OtherBC/BS-MAJOR MEDICAL
PAPE096366Medicare ID - Type UnspecifiedGROUP #