Provider Demographics
NPI:1578976015
Name:CONSORTIUM REHABILITATION, LLC
Entity Type:Organization
Organization Name:CONSORTIUM REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATREN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALTENOR
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:215-668-7100
Mailing Address - Street 1:3006 DEKALB PIKE
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-1526
Mailing Address - Country:US
Mailing Address - Phone:215-668-7100
Mailing Address - Fax:484-684-6900
Practice Address - Street 1:3006 DEKALB PIKE
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-1526
Practice Address - Country:US
Practice Address - Phone:215-668-7100
Practice Address - Fax:484-684-6900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015665251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health