MEDICARE: SKY MEDICAL AND REHABILITATION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1285502492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKY MEDICAL AND REHABILITATION LLC

Provider Business Mailing Address
First Line	:	5801 CHEW AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19138-1727
Country	:	US
Telephone Number	:	215-844-3500
Fax Number	:	215-844-3555

Provider Business Practice Location Address
First Line	:	5801 CHEW AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19138-1727
Country	:	US
Telephone Number	:	215-844-3500
Fax Number	:	215-844-3555

Authorized Official
Title or Position	:	DOCTOR OF PHYSICAL THERAPY
Name	:	DR. PAUL LEWIS EZEUKWU
Credential	:
Telephone Number	:	267-808-7249

Provider Enumeration Date	:	10/28/2025
Last Update Date	:	10/28/2025

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