Healthcare Provider Details

I. General information

NPI: 1184662116
Provider Name (Legal Business Name): SPRINGFIELD REHABILITATION ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 05/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 S NEW MIDDLETOWN ROAD SUITE 105
MEDIA PA
19063
US

IV. Provider business mailing address

176 S. NEW MIDDLETOWN ROAD SUITE 105
MEDIA PA
19063
US

V. Phone/Fax

Practice location:
  • Phone: 610-892-7344
  • Fax: 610-892-7304
Mailing address:
  • Phone: 610-892-7344
  • Fax: 610-892-7304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number05007485L
License Number StatePA

VIII. Authorized Official

Name: COLETTE A MURPHY
Title or Position: OFFICE MANAGER
Credential:
Phone: 610-892-7344