Provider Demographics
NPI:1891731741
Name:INTEGRATED MEDICAL CARE, LLC
Entity Type:Organization
Organization Name:INTEGRATED MEDICAL CARE, LLC
Other - Org Name:AQUATIC REHABILITATION & PHYSICAL THERAPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:NATALYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATYASHOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-742-7033
Mailing Address - Street 1:15501 BUSTLETON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-1187
Mailing Address - Country:US
Mailing Address - Phone:215-742-7033
Mailing Address - Fax:215-742-7034
Practice Address - Street 1:15501 BUSTLETON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-1187
Practice Address - Country:US
Practice Address - Phone:215-742-7033
Practice Address - Fax:215-742-7034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019445460004Medicaid
PA034906Medicare UPIN