Provider Demographics
NPI:1992748172
Name:TOTAL CARE PHYSICAL THERAPY AND SPORTS PHYSICIANS LTD
Entity type:Organization
Organization Name:TOTAL CARE PHYSICAL THERAPY AND SPORTS PHYSICIANS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:O'REILLY-GINDHART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-739-6780
Mailing Address - Street 1:2637 E ALLEGHENY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-5131
Mailing Address - Country:US
Mailing Address - Phone:215-739-6780
Mailing Address - Fax:215-739-6783
Practice Address - Street 1:2637 E ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-5131
Practice Address - Country:US
Practice Address - Phone:215-739-6780
Practice Address - Fax:215-739-6783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032676Y208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7551241Medicaid
PA0640653000OtherHMO ID
PAX42469Medicare UPIN
PA7551241Medicaid