1073580551 NPI number — PENN REHABILITATION ASSOCIATES, P.C.

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 1073580551 NPI number — PENN REHABILITATION ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENN REHABILITATION ASSOCIATES, P.C.
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:
1073580551
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2151 LINGLESTOWN RD
Provider Second Line Business Mailing Address:
STE. 240
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17110-9499
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-541-0700
Provider Business Mailing Address Fax Number:
717-541-5100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2151 LINGLESTOWN RD
Provider Second Line Business Practice Location Address:
STE. 240
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17110-9499
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-541-0700
Provider Business Practice Location Address Fax Number:
717-541-5100
Provider Enumeration Date:
03/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VIOLAGO
Authorized Official First Name:
EDUARDO
Authorized Official Middle Name:
SANTIAGO
Authorized Official Title or Position:
PRESIDENT/TREASURER
Authorized Official Telephone Number:
717-541-0700

Provider Taxonomy Codes

  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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