Provider Demographics
NPI:1053123513
Name:UNBOUND PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:UNBOUND PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY GROTZINGER
Authorized Official - Middle Name:
Authorized Official - Last Name:GROTZINGER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:570-847-5723
Mailing Address - Street 1:104 HAWTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-6659
Mailing Address - Country:US
Mailing Address - Phone:570-847-5723
Mailing Address - Fax:
Practice Address - Street 1:130 BUFFALO RD STE 202
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-1151
Practice Address - Country:US
Practice Address - Phone:570-847-5723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy