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General NPI Number Information
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NPI Number | 1558438754
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Entity Type | Organization
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Legal Business Name | PHOENIX PHYSICAL THERAPY REHAB CTR
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 02/06/2019
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Provider Practice Location Address
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Address Line | 4943 GERMANTOWN AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19144-5962
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Country | US
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Telephone | 215-991-9911
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Fax | 215-991-9913
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Provider Business Mailing Address
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Address Line | PO BOX 26461
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City | PHILADELPHIA
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State | PA
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Zip | 19141-6461
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Country | US
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Telephone | 215-991-9911
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Fax | 215-991-9913
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Authorized Official
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Title or Position | SOLE OWNER
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Name | LAUREN ASHLEY PREWITT
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Credential |
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Telephone | 215-991-9911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT-006992-L
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License Number State | PA
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