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General NPI Number Information
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NPI Number | 1437349131
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Entity Type | Organization
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Legal Business Name | PROACTIVE PHYSICAL MEDICINE, LLC
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Dates
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Enumeration Date | 07/29/2007
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Last Update Date | 09/01/2009
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Provider Practice Location Address
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Address Line | 1331 E WYOMING AVE SUITE 1100
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City | PHILADELPHIA
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State | PA
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Zip | 19124-3808
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Country | US
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Telephone | 215-744-4030
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Fax | 215-744-4582
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Provider Business Mailing Address
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Address Line | 1331 E WYOMING AVE SUITE 1100
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City | PHILADELPHIA
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State | PA
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Zip | 19124-3808
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Country | US
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Telephone | 215-744-4030
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Fax | 215-744-4582
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | AILEEN QUELL
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Credential |
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Telephone | 215-321-3538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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