MEDICARE: PHYSICAL CORRECTIVE SOLUTIONS, 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	261Q00000X	Clinic/Center	DC009115	PA

General Provider Information

NPI Number	:	1912397118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICAL CORRECTIVE SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	2644 LEFEVRE ST
Second Line	:	SUITE A
City	:	PHILADELPHIA
State	:	PA
Zip	:	19137-1733
Country	:	US
Telephone Number	:	215-743-5330
Fax Number	:

Provider Business Practice Location Address
First Line	:	2644 LEFEVRE ST STE A
Second Line	:	SUITE A
City	:	PHILADELPHIA
State	:	PA
Zip	:	19137-1733
Country	:	US
Telephone Number	:	215-904-7753
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANTHONY P CALANTONI
Credential	:	DC, CCEP, DAAMLP
Telephone Number	:	215-743-5330

Provider Enumeration Date	:	01/27/2015
Last Update Date	:	10/20/2015

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