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General NPI Number Information
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NPI Number | 1063013399
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Entity Type | Organization
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Legal Business Name | ORTHOPEDIC AND WELLNESS CENTER OF PHILADELPHIA PC
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Dates
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Enumeration Date | 11/03/2020
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Last Update Date | 11/13/2020
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Provider Practice Location Address
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Address Line | 205 N BROAD ST FL 6
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City | PHILADELPHIA
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State | PA
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Zip | 19107-1554
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Country | US
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Telephone | 215-496-3930
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Fax |
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Provider Business Mailing Address
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Address Line | 205 N BROAD ST FL 6
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City | PHILADELPHIA
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State | PA
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Zip | 19107-1554
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Country | US
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Telephone | 215-496-9300
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Fax | 215-496-9301
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MELISSA DAVIS
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Credential |
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Telephone | 352-396-7909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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