Healthcare Provider Details

I. General information

NPI: 1699298695
Provider Name (Legal Business Name): SPEEDWAY REHAB, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2017
Last Update Date: 09/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 NORRISTOWN RD
MAPLE GLEN PA
19002-2921
US

IV. Provider business mailing address

1925 NORRISTOWN RD
MAPLE GLEN PA
19002-2921
US

V. Phone/Fax

Practice location:
  • Phone: 610-883-7410
  • Fax:
Mailing address:
  • Phone: 610-883-7410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. WYNN A RAJAN
Title or Position: PRESIDENT
Credential: DPT
Phone: 610-883-7410