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General NPI Number Information
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NPI Number | 1720148158
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Entity Type | Organization
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Legal Business Name | CEDARS THERAPY, LLC
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 03/15/2012
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Provider Practice Location Address
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Address Line | 45 N 3RD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19106-4508
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Country | US
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Telephone | 609-922-0814
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Fax |
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Provider Business Mailing Address
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Address Line | 51 N 3RD ST # 302
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City | PHILADELPHIA
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State | PA
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Zip | 19106-4517
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Country | US
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Telephone | 609-922-0814
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. IRENE MIZOBE CONNOLLY
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Credential | PT, MS
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Telephone | 609-922-0814
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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 | PT006318L
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License Number State | PA
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