Provider Demographics
NPI:1073261475
Name:INFINITY PHYSICAL MEDICINE AND REHABILITATION, LLC
Entity Type:Organization
Organization Name:INFINITY PHYSICAL MEDICINE AND REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:TYAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-272-5685
Mailing Address - Street 1:2700 SILVERSIDE RD STE 1A
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3724
Mailing Address - Country:US
Mailing Address - Phone:302-298-1333
Mailing Address - Fax:302-485-5967
Practice Address - Street 1:2700 SILVERSIDE RD STE 1A
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-3724
Practice Address - Country:US
Practice Address - Phone:302-298-1333
Practice Address - Fax:302-485-5967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-15
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty