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General NPI Number Information
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NPI Number | 1053366690
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Entity Type | Organization
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Legal Business Name | INDEPENDENCE REHAB SERVICES PC
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 03/03/2011
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Provider Practice Location Address
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Address Line | 1030 KINGS HWY N SUITE 210
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City | CHERRY HILL
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State | NJ
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Zip | 08034-1907
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Country | US
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Telephone | 856-321-1900
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Fax | 856-321-1107
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Provider Business Mailing Address
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Address Line | 1030 KINGS HWY N SUITE 210
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City | CHERRY HILL
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State | NJ
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Zip | 08034-1907
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Country | US
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Telephone | 856-321-1900
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Fax | 856-321-1107
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MRS. SHIRVELL M THOMAS
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Credential |
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Telephone | 856-321-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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