Healthcare Provider Details

I. General information

NPI: 1285815068
Provider Name (Legal Business Name): REHAB TABCHI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 08/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 TERRY REILEY WAY
POTTSVILLE PA
17901-1774
US

IV. Provider business mailing address

421 CHEW STREET
ALLENTOWN PA
18102-3406
US

V. Phone/Fax

Practice location:
  • Phone: 570-624-4444
  • Fax:
Mailing address:
  • Phone: 610-776-5315
  • Fax: 610-663-3107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT011973
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS015215
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: