Provider Demographics
NPI:1194994228
Name:PLAZA PHYSICAL THERAPY
Entity type:Organization
Organization Name:PLAZA PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KIRBY
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:267-574-8110
Mailing Address - Street 1:339-343 EAST STREET ROAD
Mailing Address - Street 2:STERNER'S MILL OFFICE COMPLEX
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053
Mailing Address - Country:US
Mailing Address - Phone:267-574-8110
Mailing Address - Fax:267-574-8111
Practice Address - Street 1:339-343 EAST STREET ROAD
Practice Address - Street 2:STERNER'S MILL OFFICE COMPLEX
Practice Address - City:TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053
Practice Address - Country:US
Practice Address - Phone:267-574-8110
Practice Address - Fax:267-574-8111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013564L261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2076570000OtherINDEPENDENCE BLUE SHIELD