Provider Demographics
NPI:1689010670
Name:THERAPEUTIC MUSCLE SOLUTIONS
Entity Type:Organization
Organization Name:THERAPEUTIC MUSCLE SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SOMERVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, COTA
Authorized Official - Phone:484-682-4442
Mailing Address - Street 1:168 HUDSON DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-5648
Mailing Address - Country:US
Mailing Address - Phone:484-682-4442
Mailing Address - Fax:801-504-4336
Practice Address - Street 1:168 HUDSON DR
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-5648
Practice Address - Country:US
Practice Address - Phone:484-682-4442
Practice Address - Fax:801-504-4336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006867261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation