Provider Demographics
NPI:1003010646
Name:NOVACARE REHABILITATION
Entity Type:Organization
Organization Name:NOVACARE REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BILLHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-992-7224
Mailing Address - Street 1:4812 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-4125
Mailing Address - Country:US
Mailing Address - Phone:215-324-6082
Mailing Address - Fax:
Practice Address - Street 1:511 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-3230
Practice Address - Country:US
Practice Address - Phone:215-923-8269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT009919E261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy