Provider Demographics
NPI:1992755698
Name:ORTHOPEDIC AND SPORTS PHYSICAL THERAPY SERVICES, INC.
Entity type:Organization
Organization Name:ORTHOPEDIC AND SPORTS PHYSICAL THERAPY SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:OSTROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:215-629-3837
Mailing Address - Street 1:420 BAINBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1568
Mailing Address - Country:US
Mailing Address - Phone:215-629-3837
Mailing Address - Fax:215-629-5531
Practice Address - Street 1:9389 KREWSTOWN RD
Practice Address - Street 2:NORTHEAST RACQUET CLUB & FITNESS CENTER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-3710
Practice Address - Country:US
Practice Address - Phone:215-676-6760
Practice Address - Fax:215-676-3746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0213007OtherORTHONET
PA0444631000OtherBCBS HMO GROUP#
PA966448OtherBCBS PPO GROUP #
PA118100602OtherUS DEPT OF LABOR
PA99493OtherAETNA HMO GROUP#
PA4566762OtherAETNA PPO GROUP#
PA99493OtherAETNA HMO GROUP#