Healthcare Provider Details

I. General information

NPI: 1174758981
Provider Name (Legal Business Name): THE CENTER FOR ADVANCED WOUND CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2009
Last Update Date: 05/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 RIDGEWOOD RD SUITE 190
WYOMISSING PA
19610-1189
US

IV. Provider business mailing address

2201 RIDGEWOOD RD SUITE 190
WYOMISSING PA
19610-1189
US

V. Phone/Fax

Practice location:
  • Phone: 610-373-5500
  • Fax: 610-373-5600
Mailing address:
  • Phone: 610-373-5500
  • Fax: 610-373-5600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD039223L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT016859
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT015079
License Number StatePA

VIII. Authorized Official

Name: DR. JOSEPH P CAVORSI
Title or Position: CEO
Credential: M.D.
Phone: 610-373-5500