Organization
PAOLI SPORTS MEDICINE AND REHABILITATION CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH MICHAEL CORCORAN PT (OWNER)
(610) 647-1996
Entity
Organization
Contact information
Practice address
30 S VALLEY RD, SUITE 102, PAOLI, PA 19301-1469
(610) 647-1996
(610) 408-8677
Mailing address
30 S VALLEY RD, SUITE 102, PAOLI, PA 19301-1450
(610) 647-1996
(610) 408-8677
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT-000620-E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1173150001
DME NUMBER
PA
01
—
8495471
AETNA ID NUMBER
PA
01
—
DB4763
RR MEDICARE NUMBER
PA
Enumeration date
10/23/2006
Last updated
08/27/2013
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