Provider Demographics
NPI:1134307424
Name:PENN REHAB AGENCY AT RADNOR
Entity Type:Organization
Organization Name:PENN REHAB AGENCY AT RADNOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASOCIATE VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-662-2709
Mailing Address - Street 1:250 KING OF PRUSSIA RD
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:RADNOR
Mailing Address - State:PA
Mailing Address - Zip Code:19087-5220
Mailing Address - Country:US
Mailing Address - Phone:215-349-5150
Mailing Address - Fax:215-615-0432
Practice Address - Street 1:250 KING OF PRUSSIA RD
Practice Address - Street 2:SUITE 2C
Practice Address - City:RADNOR
Practice Address - State:PA
Practice Address - Zip Code:19087-5220
Practice Address - Country:US
Practice Address - Phone:215-349-5150
Practice Address - Fax:215-615-0432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396741Medicare Oscar/Certification