Provider Demographics
NPI:1912026170
Name:ATLANTIC REHAB SERVICES ASSOCIATES
Entity Type:Organization
Organization Name:ATLANTIC REHAB SERVICES ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:C
Authorized Official - Middle Name:
Authorized Official - Last Name:DONESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-244-0235
Mailing Address - Street 1:2221 GALLOWAY RD
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-2917
Mailing Address - Country:US
Mailing Address - Phone:215-244-0235
Mailing Address - Fax:215-244-3265
Practice Address - Street 1:2221 GALLOWAY RD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-2917
Practice Address - Country:US
Practice Address - Phone:215-244-0235
Practice Address - Fax:215-244-3265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005218L225100000X
PADAPT001179225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0662571000OtherBLUE CROSS
PA0662571000OtherBLUE CROSS