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General NPI Number Information
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NPI Number | 1083859524
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Entity Type | Organization
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Legal Business Name | LIBERTY WHEELS, LLC
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Dates
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Enumeration Date | 12/12/2008
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Last Update Date | 07/23/2010
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Provider Practice Location Address
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Address Line | 714 MARKET ST STE 101
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City | PHILADELPHIA
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State | PA
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Zip | 19106-2326
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Country | US
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Telephone | 215-634-2000
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Fax | 215-701-4976
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Provider Business Mailing Address
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Address Line | 714 MARKET ST STE 101
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City | PHILADELPHIA
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State | PA
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Zip | 19106-2326
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Country | US
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Telephone | 267-765-1530
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Fax | 215-627-2481
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Authorized Official
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Title or Position | CAO
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Name | MR. FADY SAHHAR
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Credential |
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Telephone | 215-634-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 84639725
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License Number State | PA
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