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General NPI Number Information
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NPI Number | 1841467388
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Entity Type | Organization
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Legal Business Name | CORE PERFORMANCE AND REHABILITATION
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Dates
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Enumeration Date | 05/14/2008
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 2981 GRANT AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19114-1012
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Country | US
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Telephone | 215-860-3623
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Fax | 215-860-3763
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Provider Business Mailing Address
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Address Line | PO BOX 74
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City | FAIRLESS HILLS
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State | PA
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Zip | 19030-0074
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Country | US
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Telephone | 215-860-3623
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KIM VOLPACCHIO
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Credential |
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Telephone | 215-860-3623
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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 | DC006032L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT008765E
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License Number State | PA
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