Provider Demographics
NPI:1942354402
Name:PACE PHYSICAL THERAPY
Entity type:Organization
Organization Name:PACE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:570-675-8151
Mailing Address - Street 1:201 MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-1240
Mailing Address - Country:US
Mailing Address - Phone:570-675-8151
Mailing Address - Fax:
Practice Address - Street 1:201 MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-1240
Practice Address - Country:US
Practice Address - Phone:570-675-8151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005230L261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy