Healthcare Provider Details

I. General information

NPI: 1720096746
Provider Name (Legal Business Name): NORTHWEST REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 S 17TH ST SUITE 2001
PHILADELPHIA PA
19103-6231
US

IV. Provider business mailing address

255 S 17TH ST SUITE 2001
PHILADELPHIA PA
19103-6231
US

V. Phone/Fax

Practice location:
  • Phone: 215-546-7049
  • Fax: 215-546-8646
Mailing address:
  • Phone: 215-546-7049
  • Fax: 215-546-8646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. GREGORY ALLEN NELSON
Title or Position: CEO
Credential: M.D.
Phone: 215-546-7049