Provider Demographics
NPI:1639691769
Name:MEDRISK IPA LLC
Entity Type:Organization
Organization Name:MEDRISK IPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRODUCT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:610-513-3043
Mailing Address - Street 1:2701 RENAISSANCE BLVD
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2781
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2701 RENAISSANCE BLVD
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2781
Practice Address - Country:US
Practice Address - Phone:610-768-5812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDRISK LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-11
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty