Provider Demographics
NPI:1740385814
Name:NORTHEAST AQUA AND PHYSICAL THERAPY CENTER INC
Entity Type:Organization
Organization Name:NORTHEAST AQUA AND PHYSICAL THERAPY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUSLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLOSHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-969-2101
Mailing Address - Street 1:9150 MARSHALL ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-2217
Mailing Address - Country:US
Mailing Address - Phone:215-969-2101
Mailing Address - Fax:
Practice Address - Street 1:9150 MARSHALL ST
Practice Address - Street 2:SUITE 9
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-2217
Practice Address - Country:US
Practice Address - Phone:215-969-2101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA085022Medicare ID - Type Unspecified