Organization
SPORTS AND BACK REHABILITATION INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA M PETERS PT (PRESIDENT/OWNER)
(215) 752-4553
Entity
Organization
Contact information
Practice address
370 E MAPLE AVE, SUITE 103, LANGHORNE, PA 19047-2859
(215) 752-4553
(215) 752-0703
Mailing address
370 E MAPLE AVE, SUITE 103, LANGHORNE, PA 19047-2859
(215) 752-4553
(215) 752-0703
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0053616
AETNA
PA
01
—
0423943000
INDEPENDENCE BLUE CROSS
PA
Enumeration date
06/14/2006
Last updated
04/18/2011
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