Provider Demographics
NPI:1194770842
Name:BROOMALL REHAB SERVICES INC.
Entity type:Organization
Organization Name:BROOMALL REHAB SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-359-1134
Mailing Address - Street 1:1999 SPROUL RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3508
Mailing Address - Country:US
Mailing Address - Phone:610-359-1134
Mailing Address - Fax:610-353-2109
Practice Address - Street 1:1999 SPROUL RD
Practice Address - Street 2:SUITE 10
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3508
Practice Address - Country:US
Practice Address - Phone:610-359-1134
Practice Address - Fax:610-353-2109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0073983000OtherINDEPENDENCE BLUE CROSS
PA0073983000OtherINDEPENDENCE BLUE CROSS