# PEDIATRIC REHABILITATION ASSOCIATES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558811372
- **Authorized official:** CONNIE DOMINGO MD (PRESIDENT)
- **Authorized official phone:** (609) 410-8055

## Contact information

- **Practice address:** 92 BRICK RD FL 3, MARLTON, NJ 08053-2177
- **Practice address phone:** (856) 489-4520
- **Mailing address:** PO BOX 674, MARLTON, NJ 08053-0674

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2081P0010X | Pediatric Rehabilitation Medicine Physician | 25MA06376400 | NJ | Yes |

## Other

- **Enumeration date:** 10/04/2016
- **Last updated:** 02/27/2017