Provider Demographics
NPI:1316605462
Name:CENTRALIZED SPINE, LLC
Entity type:Organization
Organization Name:CENTRALIZED SPINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNING
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, CERT, MDT
Authorized Official - Phone:484-442-8103
Mailing Address - Street 1:120 CEDAR CT
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5444
Mailing Address - Country:US
Mailing Address - Phone:484-442-8103
Mailing Address - Fax:484-442-8376
Practice Address - Street 1:200 W BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3150
Practice Address - Country:US
Practice Address - Phone:484-442-8103
Practice Address - Fax:484-442-8376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty