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General NPI Number Information
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NPI Number | 1093831414
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Entity Type | Organization
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Legal Business Name | FIRST AVEUNUE OCCUPATIONAL MEDICINE,LLC
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 860 1ST AVE SUITE870
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-1404
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Country | US
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Telephone | 610-265-3200
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Fax | 610-265-6522
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Provider Business Mailing Address
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Address Line | 860 1ST AVE SUITE870
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-1404
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Country | US
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Telephone | 610-265-3200
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Fax | 610-265-6522
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Authorized Official
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Title or Position | DIRECTOR OF PHYSICAL THERAPY
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Name | EDWRAD ORUCH
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Credential | PT
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Telephone | 610-265-3200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT005823L
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License Number State | PA
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