Healthcare Provider Details

I. General information

NPI: 1881118727
Provider Name (Legal Business Name): CPR REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 08/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10890 BUSTLETON AVE STE 103
PHILADELPHIA PA
19116-3365
US

IV. Provider business mailing address

10890 BUSTLETON AVE STE 103
PHILADELPHIA PA
19116-3365
US

V. Phone/Fax

Practice location:
  • Phone: 215-464-6104
  • Fax:
Mailing address:
  • Phone: 215-464-6104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: FELIX SHAFARENKO
Title or Position: OWNER
Credential:
Phone: 215-464-6104