Mindful Physical Therapy

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

PT-003491-L Issued in PA

Legal business name

MINDFUL PHYSICAL THERAPY

Practice address

119 Shippen Rd
Erdenheim, PA 19038-7306

Phone

(267) 432-1795

NPI assigned

May 1, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Joanne P Fagerstrom, PT

Title

Physical Therapist

Phone

(267) 432-1795

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1367366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367366400000",
    "number": "1013352244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 SHIPPEN RD",
            "city": "ERDENHEIM",
            "state": "PA",
            "postal_code": "190387306",
            "telephone_number": "267-432-1795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 SHIPPEN RD",
            "city": "ERDENHEIM",
            "state": "PA",
            "postal_code": "190387306",
            "telephone_number": "267-432-1795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDFUL PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-01",
        "last_updated": "2013-05-01",
        "status": "A",
        "authorized_official_last_name": "FAGERSTROM",
        "authorized_official_first_name": "JOANNE",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "267-432-1795",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "PA",
            "license": "PT-003491-L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1053558171",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Merakey New Jersey
• Merakey Pennsylvania
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• NHS Stevens Center
• NHS Stevens Center
• Nspire You
• Jacquelyn O'Malley, M.ED

• All providers in Erdenheim, PA
• Physical Therapy Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.