Provider Demographics
NPI:1487785978
Name:MIND & BODY FITNESS, INC
Entity type:Organization
Organization Name:MIND & BODY FITNESS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:SUSPENSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ATC
Authorized Official - Phone:610-269-5070
Mailing Address - Street 1:797 E LANCASTER AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-3315
Mailing Address - Country:US
Mailing Address - Phone:610-269-5070
Mailing Address - Fax:610-269-5074
Practice Address - Street 1:797 E LANCASTER AVE STE 2
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-3315
Practice Address - Country:US
Practice Address - Phone:610-269-5070
Practice Address - Fax:610-269-5074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT001192E2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA054613Medicare UPIN