Provider Demographics
NPI:1316990427
Name:SWEENEY, JOHN M
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M
Last Name:SWEENEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT 005149L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA541985OtherBC/BS
PA689303OtherUHC
E41985OtherINTER-COUNTY/AMERIHEALTH
PA0211500OtherORTHONET/CIGNA
PA7387717Medicaid
PA0271571000OtherKHPE
PA05071730OtherAETNA
PA541985OtherBC/BS
PA689303OtherUHC