Organization Name: | WALLACE & NILAN PHYSICAL THERAPY AND FITNESS, LLC |
NPI Number: | 1417916016 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ROSS NILAN (OWNER) |
Mailing Address: | 1600 Bethlehem Pike Flourtown |
State: | PA US |
Postal Code: | 190312026 |
Phone Number: | 2152339677 |
Fax Number: | 2152339498 |
NPI Enumeration Date: | 03/22/2006 |
NPI Last Update Date: | 06/15/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |