Provider Demographics
NPI:1881118727
Name:CPR REHABILITATION
Entity type:Organization
Organization Name:CPR REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFARENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-464-6104
Mailing Address - Street 1:10890 BUSTLETON AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-3365
Mailing Address - Country:US
Mailing Address - Phone:215-464-6104
Mailing Address - Fax:
Practice Address - Street 1:10890 BUSTLETON AVE STE 103
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-3365
Practice Address - Country:US
Practice Address - Phone:215-464-6104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization