Provider Demographics
NPI:1699298695
Name:SPEEDWAY REHAB, PC
Entity type:Organization
Organization Name:SPEEDWAY REHAB, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WYNN
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:610-883-7410
Mailing Address - Street 1:1925 NORRISTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE GLEN
Mailing Address - State:PA
Mailing Address - Zip Code:19002-2921
Mailing Address - Country:US
Mailing Address - Phone:610-883-7410
Mailing Address - Fax:
Practice Address - Street 1:1925 NORRISTOWN RD
Practice Address - Street 2:
Practice Address - City:MAPLE GLEN
Practice Address - State:PA
Practice Address - Zip Code:19002-2921
Practice Address - Country:US
Practice Address - Phone:610-883-7410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy