Provider Demographics
NPI:1912091190
Name:CONSHOHOCKEN PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:CONSHOHOCKEN PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DESIREA
Authorized Official - Middle Name:D
Authorized Official - Last Name:CAUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:610-828-7595
Mailing Address - Street 1:20 E 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1555
Mailing Address - Country:US
Mailing Address - Phone:610-828-7595
Mailing Address - Fax:610-828-7505
Practice Address - Street 1:20 E 11TH AVE
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-1555
Practice Address - Country:US
Practice Address - Phone:610-828-7595
Practice Address - Fax:610-828-7505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015693261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA17588OtherAMERIHEALTH ADMINISTRATOR
PA3498858OtherAETNA NON PAR
PA1417588OtherHIGHMARK BS INDIVIDUAL
PA0220700OtherORTHONET
PA700260OtherUNITED HEALTHCARE/ACN
PA1732275OtherHIGHMARK BS GROUP
PA5630094OtherFIRST HEALTH
PA737511OtherNCPPO
PA7385670OtherAWCA INDIVIDUAL
PA2402306OtherINDEPENDENCE BC GROUP
PA1881699213OtherINDIVIDUAL NPI
PA2103996000OtherINDEPENDENCE BC INDIV
PA7051525OtherAWCA GROUP
PA8279722OtherCIGNA
PA=========OtherTRICARE
PA737511OtherNCPPO
PA8279722OtherCIGNA