1164446373 NPI number — DYNAMIC REHABILITATION SERVICES INC

Table of content: (NPI 1164446373)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164446373 NPI number — DYNAMIC REHABILITATION SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DYNAMIC REHABILITATION SERVICES INC
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:
1164446373
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8080 OLD YORK RD
Provider Second Line Business Mailing Address:
SUITE 208
Provider Business Mailing Address City Name:
ELKINS PARK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19027-1421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-782-8760
Provider Business Mailing Address Fax Number:
215-635-7130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8080 OLD YORK RD
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
ELKINS PARK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19027-1421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-782-8760
Provider Business Practice Location Address Fax Number:
215-635-7130
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BAYLINSON
Authorized Official First Name:
HUGH
Authorized Official Middle Name:
F
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
215-782-8760

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 205616 . This is a "HIGHMARK BC/BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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