Provider Demographics
NPI:1689678369
Name:MOHACEY, PETER MICHAEL (MPT)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:MICHAEL
Last Name:MOHACEY
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 HAGUES MILL RD
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-6000
Mailing Address - Country:US
Mailing Address - Phone:215-646-2025
Mailing Address - Fax:
Practice Address - Street 1:270 COMMERCE DR
Practice Address - Street 2:STE 190
Practice Address - City:FT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-2405
Practice Address - Country:US
Practice Address - Phone:215-654-1520
Practice Address - Fax:215-654-1529
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007797L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2112462000OtherKEYSTONE HEALTHPLAN EAST
PA1426092OtherIBC
PA3104173OtherAETNA
PA066330Medicare ID - Type Unspecified