Provider Demographics
NPI:1366657850
Name:PHYSICIANS REHABILITATION SERVICES, PC
Entity Type:Organization
Organization Name:PHYSICIANS REHABILITATION SERVICES, PC
Other - Org Name:WISSAHICKON PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHAEFER
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:215-233-6145
Mailing Address - Street 1:5 W. WISSAHICKON AVENUE
Mailing Address - Street 2:
Mailing Address - City:FLOURTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19031-1917
Mailing Address - Country:US
Mailing Address - Phone:215-233-6145
Mailing Address - Fax:215-233-6147
Practice Address - Street 1:5 W. WISSAHICKON AVENUE
Practice Address - Street 2:
Practice Address - City:FLOURTOWN
Practice Address - State:PA
Practice Address - Zip Code:19031-1917
Practice Address - Country:US
Practice Address - Phone:215-233-6145
Practice Address - Fax:215-233-6147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
PAPT019722225100000X
PAPT018431225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA058314Medicare ID - Type Unspecified