Organization
CHESAPEAKE MEDICAL SUPPLY, INC
Active
Other names
Philadelphia Rehab
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID E BOUSLOG ATP (PRESIDENT)
(215) 755-0255
Entity
Organization
Contact information
Practice address
937 CHESTER PIKE, 4M, PROSPECT PARK, PA 19076-2331
(215) 755-0255
Mailing address
937 CHESTER PIKE, 4M, PROSPECT PARK, PA 19076-2331
(215) 755-0255
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
6000004048
PA
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000538218
—
DE
05
—
0012883280002
—
PA
Enumeration date
02/09/2007
Last updated
02/27/2012
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