Provider Demographics
NPI:1316902885
Name:PA REHAB ASSOCIATES PC
Entity type:Organization
Organization Name:PA REHAB ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PASQUALE
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLAVITA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-334-3869
Mailing Address - Street 1:PO BOX 709
Mailing Address - Street 2:
Mailing Address - City:GLADWYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19035-0709
Mailing Address - Country:US
Mailing Address - Phone:610-734-0630
Mailing Address - Fax:610-734-0874
Practice Address - Street 1:2230 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-3950
Practice Address - Country:US
Practice Address - Phone:215-334-3869
Practice Address - Fax:215-755-3300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
075712Medicare ID - Type Unspecified
PA075712Medicare PIN