Provider Demographics
NPI:1811521115
Name:POCONO FUNCTIONAL REHABILITATION, PLLC
Entity type:Organization
Organization Name:POCONO FUNCTIONAL REHABILITATION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAE MARIE
Authorized Official - Middle Name:JACQUELINE
Authorized Official - Last Name:VENARUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-226-4119
Mailing Address - Street 1:74 WELWOOD AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:HAWLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18428-1577
Mailing Address - Country:US
Mailing Address - Phone:570-226-4119
Mailing Address - Fax:
Practice Address - Street 1:74 WELWOOD AVE STE 101
Practice Address - Street 2:
Practice Address - City:HAWLEY
Practice Address - State:PA
Practice Address - Zip Code:18428-1577
Practice Address - Country:US
Practice Address - Phone:570-226-4119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty