Provider Demographics
NPI:1780871178
Name:PHILADELPHIA REHABILITATION & SPORTS MEDICINE
Entity type:Organization
Organization Name:PHILADELPHIA REHABILITATION & SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUEST
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:267-738-6040
Mailing Address - Street 1:1407 RHAWN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-2803
Mailing Address - Country:US
Mailing Address - Phone:215-722-3948
Mailing Address - Fax:
Practice Address - Street 1:1407 RHAWN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2803
Practice Address - Country:US
Practice Address - Phone:267-738-6040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007450L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014814440008Medicaid
PA0014814440008Medicaid
PA061374Medicare PIN