NPIMap

Organization Active NPI

South Mountain Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Sinking Spring, PA
National Provider Identifier
1932374113
Registry record updated May 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
PT010933L Issued in PA
Legal business name
SOUTH MOUNTAIN PHYSICAL THERAPY LLC
Practice address
4740 Penn Ave
Sinking Spring, PA 19608-9672
Phone
(610) 927-5183
Fax
(610) 927-6994
NPI assigned
Apr 28, 2008
Last updated
May 23, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2022

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

Authorized official

Name
Kai H. Pedersen, PTNPI 1487612487
Title
Owner
Phone
(610) 927-5183

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X PT010933L PA Primary

Addresses

Primary practice location

4740 Penn Ave
Sinking Spring, PA 19608-9672

Mailing address

4740 Penn Ave
Sinking Spring, PA 19608-9672
Phone (610) 927-5183

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080922000268 PA Part B Supplier - Clinic/Group Practice 4981771631 Receives reassigned benefits from 13 practitioners
Practice locations: Leesport, PA; Sinking Spring, PA

National Provider Directory

National Provider Directory

Locations

4740 Penn Ave
Sinking Spring, PA 19608
Phone (610) 927-5183

4728 Penn Ave
South Heidelberg, PA 19608
Phone (610) 927-5183

243 N Galen Hall Rd
Wernersville, PA 19565
Phone (610) 678-2332

600 E Penn Ave
Ste 1
Wernersville, PA 19565
Phone (610) 927-5183

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1209340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653264000000",
    "number": "1932374113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4740 PENN AVE",
            "city": "SINKING SPRING",
            "state": "PA",
            "postal_code": "196089672",
            "telephone_number": "610-927-5183",
            "fax_number": "610-927-6994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4740 PENN AVE",
            "city": "SINKING SPRING",
            "state": "PA",
            "postal_code": "196089672",
            "telephone_number": "610-927-5183",
            "fax_number": "610-927-6994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH MOUNTAIN PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-28",
        "last_updated": "2022-05-23",
        "certification_date": "2022-05-23",
        "status": "A",
        "authorized_official_last_name": "PEDERSEN",
        "authorized_official_first_name": "KAI",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "610-927-5183",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "PA",
            "license": "PT010933L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sinking Spring, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.