Organization
MINDFUL PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JOANNE P FAGERSTROM PT (PHYSICAL THERAPIST)
(267) 432-1795
Entity
Organization
Contact information
Practice address
119 SHIPPEN RD, ERDENHEIM, PA 19038-7306
(267) 432-1795
Mailing address
119 SHIPPEN RD, ERDENHEIM, PA 19038-7306
(267) 432-1795
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
PT-003491-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1053558171
INDIVIDUAL NPI
PA
Enumeration date
05/01/2013
Last updated
05/01/2013
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