Provider Demographics
NPI:1386942399
Name:TOTAL BODY PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:TOTAL BODY PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRESPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-673-4100
Mailing Address - Street 1:1094 WELSH RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-2805
Mailing Address - Country:US
Mailing Address - Phone:215-673-4100
Mailing Address - Fax:215-673-4200
Practice Address - Street 1:1094 WELSH RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-2805
Practice Address - Country:US
Practice Address - Phone:215-673-4100
Practice Address - Fax:215-673-4200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011328LL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty