Provider Demographics
NPI:1215123088
Name:JOHN SWEENEY PHYSICAL THERAPY
Entity type:Organization
Organization Name:JOHN SWEENEY PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SWEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:215-887-0820
Mailing Address - Street 1:216 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:ORELAND
Mailing Address - State:PA
Mailing Address - Zip Code:19075-1230
Mailing Address - Country:US
Mailing Address - Phone:215-887-0820
Mailing Address - Fax:215-887-0689
Practice Address - Street 1:216 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:ORELAND
Practice Address - State:PA
Practice Address - Zip Code:19075-1230
Practice Address - Country:US
Practice Address - Phone:215-887-0820
Practice Address - Fax:215-887-0689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005149L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
083060Medicare PIN