Provider Demographics
NPI:1609937119
Name:FREEDOM PHYSICAL REHAB, LLC
Entity Type:Organization
Organization Name:FREEDOM PHYSICAL REHAB, LLC
Other - Org Name:LIFELINE SPECIALTY OUTPATIENT CENTERS-PHYSICAL THERAPY AND PULMOANRY R
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GERMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-941-5340
Mailing Address - Street 1:4000 WATERDAM PLAZA DR
Mailing Address - Street 2:260
Mailing Address - City:MCMURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2494
Mailing Address - Country:US
Mailing Address - Phone:724-941-5340
Mailing Address - Fax:724-941-5341
Practice Address - Street 1:4000 WATERDAM PLAZA DR
Practice Address - Street 2:260
Practice Address - City:MCMURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2494
Practice Address - Country:US
Practice Address - Phone:724-941-5340
Practice Address - Fax:724-941-5341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013013L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA=========OtherTAX ID