Healthcare Provider Details

I. General information

NPI: 1447791504
Provider Name (Legal Business Name): INJURY CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2017
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W ASHLAND AVE
GLENOLDEN PA
19036-1101
US

IV. Provider business mailing address

901 W ASHLAND AVE
GLENOLDEN PA
19036-1101
US

V. Phone/Fax

Practice location:
  • Phone: 610-461-6522
  • Fax:
Mailing address:
  • Phone: 610-461-6522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberTE011328
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KATHY AIKENS
Title or Position: HUMAN RESOURCE MANAGER
Credential:
Phone: 484-494-5604