Provider Demographics
NPI:1992735278
Name:PHYSICIANS REHABILITATION ASSOCIATES P C
Entity type:Organization
Organization Name:PHYSICIANS REHABILITATION ASSOCIATES P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-237-4612
Mailing Address - Street 1:PO BOX 41654
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101-1654
Mailing Address - Country:US
Mailing Address - Phone:610-237-5006
Mailing Address - Fax:610-237-4138
Practice Address - Street 1:1503 LANSDOWNE AVE
Practice Address - Street 2:
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1330
Practice Address - Country:US
Practice Address - Phone:610-237-5006
Practice Address - Fax:610-237-4138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001203080Medicaid
PA603977Medicare ID - Type Unspecified