Provider Demographics
NPI:1184662116
Name:SPRINGFIELD REHABILITATION ASSOCIATES, LLC
Entity Type:Organization
Organization Name:SPRINGFIELD REHABILITATION ASSOCIATES, LLC
Other - Org Name:SMART REHABILITATION ASSOCIATES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:COLETTE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-892-7344
Mailing Address - Street 1:176 S. NEW MIDDLETOWN ROAD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063
Mailing Address - Country:US
Mailing Address - Phone:610-892-7344
Mailing Address - Fax:610-892-7304
Practice Address - Street 1:176 S NEW MIDDLETOWN ROAD
Practice Address - Street 2:SUITE 105
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063
Practice Address - Country:US
Practice Address - Phone:610-892-7344
Practice Address - Fax:610-892-7304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05007485L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF04423Medicare UPIN
PA055575Medicare ID - Type Unspecified