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General NPI Number Information
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NPI Number | 1164814059
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Entity Type | Organization
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Legal Business Name | WILLOW GROVE GET WELL
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Dates
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Enumeration Date | 03/02/2015
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Last Update Date | 12/09/2015
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Provider Practice Location Address
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Address Line | 612 FITZWATERTOWN RD
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City | WILLOW GROVE
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State | PA
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Zip | 19090-1904
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Country | US
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Telephone | 215-366-7363
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Fax | 215-366-7393
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Provider Business Mailing Address
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Address Line | 612 FITZWATERTOWN RD
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City | WILLOW GROVE
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State | PA
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Zip | 19090-1904
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Country | US
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Telephone | 215-366-7363
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Fax | 215-366-7393
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LYNNE GUARNACCIA
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Credential |
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Telephone | 215-366-7363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | DC006600Y
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License Number State | PA
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