1043648629 NPI number — REBALANCE PHYSICAL THERAPY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043648629 NPI number — REBALANCE PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REBALANCE PHYSICAL THERAPY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043648629
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
465 CLOTHIER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WYNNEWOOD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19096-2345
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-282-1301
Provider Business Mailing Address Fax Number:
267-940-1300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
234 WOODBINE AVE
Provider Second Line Business Practice Location Address:
2ND FL
Provider Business Practice Location Address City Name:
NARBERTH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19072-1930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-282-1301
Provider Business Practice Location Address Fax Number:
267-940-1300
Provider Enumeration Date:
10/17/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SHETH
Authorized Official First Name:
HINA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
646-369-5072

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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