Provider Demographics
NPI:1639654395
Name:PHILADELPHIA REHAB, INC.
Entity Type:Organization
Organization Name:PHILADELPHIA REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:BOUSLOG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-755-0255
Mailing Address - Street 1:13 RIVERWATCH CT
Mailing Address - Street 2:
Mailing Address - City:ESSINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19029-1432
Mailing Address - Country:US
Mailing Address - Phone:215-755-0255
Mailing Address - Fax:
Practice Address - Street 1:13 RIVERWATCH CT
Practice Address - Street 2:
Practice Address - City:ESSINGTON
Practice Address - State:PA
Practice Address - Zip Code:19029-1432
Practice Address - Country:US
Practice Address - Phone:215-755-0255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies