Healthcare Provider Details

I. General information

NPI: 1134307424
Provider Name (Legal Business Name): PENN REHAB AGENCY AT RADNOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 KING OF PRUSSIA RD SUITE 2C
RADNOR PA
19087-5220
US

IV. Provider business mailing address

250 KING OF PRUSSIA RD SUITE 2C
RADNOR PA
19087-5220
US

V. Phone/Fax

Practice location:
  • Phone: 215-349-5150
  • Fax: 215-615-0432
Mailing address:
  • Phone: 215-349-5150
  • Fax: 215-615-0432

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: MR. THOMAS MCCORMICK
Title or Position: ASOCIATE VICE PRESIDENT OF FINANCE
Credential:
Phone: 215-662-2709