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General NPI Number Information
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NPI Number | 1154714905
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Entity Type | Organization
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Legal Business Name | REJUVENATIONS HEALTHCARE & REHABILITATION
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Dates
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Enumeration Date | 03/17/2015
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Last Update Date | 03/17/2015
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Provider Practice Location Address
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Address Line | 813 ADAMS AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19124-2477
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Country | US
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Telephone | 215-305-3300
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Fax | 215-305-3301
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Provider Business Mailing Address
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Address Line | 813 ADAMS AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19124-2477
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Country | US
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Telephone | 215-305-3300
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Fax | 215-305-3301
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Authorized Official
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Title or Position | OWNER
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Name | PETER DEAN REDMOND
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Credential | D.C
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Telephone | 215-305-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC006411L
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License Number State | PA
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