Provider Demographics
NPI:1235362708
Name:ADVANCED PHYSICAL MEDICINE ASSOCIATES
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAE MARIE
Authorized Official - Middle Name:JACQUELINE
Authorized Official - Last Name:VENARUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-451-1133
Mailing Address - Street 1:102 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OLD FORGE
Mailing Address - State:PA
Mailing Address - Zip Code:18518-1726
Mailing Address - Country:US
Mailing Address - Phone:570-451-1133
Mailing Address - Fax:570-451-0541
Practice Address - Street 1:102 N MAIN ST
Practice Address - Street 2:
Practice Address - City:OLD FORGE
Practice Address - State:PA
Practice Address - Zip Code:18518-1726
Practice Address - Country:US
Practice Address - Phone:570-451-1133
Practice Address - Fax:570-451-0541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty