Provider Demographics
NPI:1639292063
Name:CAMBRIAN REHABILITATION ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:CAMBRIAN REHABILITATION ASSOCIATES, P.C.
Other - Org Name:PENNCARE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO- OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BURMEISTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:BSPT
Authorized Official - Phone:814-672-5700
Mailing Address - Street 1:850 MAIN STREET
Mailing Address - Street 2:SUITE 4, P.O. BOX 207
Mailing Address - City:COALPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16627-0207
Mailing Address - Country:US
Mailing Address - Phone:814-672-5700
Mailing Address - Fax:814-672-5702
Practice Address - Street 1:850 MAIN STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:COALPORT
Practice Address - State:PA
Practice Address - Zip Code:16627-0207
Practice Address - Country:US
Practice Address - Phone:814-672-5700
Practice Address - Fax:814-672-5702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT 006763-L261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA005842OtherHIGHMARK GROUP PROVIDER
PA01896995Medicaid
PA01896995Medicaid