Healthcare Provider Details

I. General information

NPI: 1982147161
Provider Name (Legal Business Name): WRC SPORTS AND FITNESS LIMITED PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3103 PAPERMILL RD
WYOMISSING PA
19610-3337
US

IV. Provider business mailing address

3103 PAPERMILL RD
WYOMISSING PA
19610-3337
US

V. Phone/Fax

Practice location:
  • Phone: 610-376-2100
  • Fax: 610-376-4131
Mailing address:
  • Phone: 610-376-2100
  • Fax: 610-376-4131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TED KOLVA
Title or Position: GENERAL MANAGER
Credential:
Phone: 610-376-2100