Provider Demographics
NPI:1205502846
Name:ORTHOTELEREHAB LLC
Entity type:Organization
Organization Name:ORTHOTELEREHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENO
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, CERT MDT
Authorized Official - Phone:267-626-7146
Mailing Address - Street 1:137 BRITTANY DR
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-2303
Mailing Address - Country:US
Mailing Address - Phone:267-626-7146
Mailing Address - Fax:
Practice Address - Street 1:137 BRITTANY DR
Practice Address - Street 2:
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914-2303
Practice Address - Country:US
Practice Address - Phone:267-626-7146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy