Organization
LOWER MERION REHABILITATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CAROL J DEBAKKER M.D. (PRESIDENT)
(844) 476-3391
Entity
Organization
Contact information
Practice address
100 E LANCASTER AVE STE B7, WYNNEWOOD, PA 19096-3450
(484) 476-3391
(866) 848-9001
Mailing address
PO BOX 457, WYNNEWOOD, PA 19096-0457
(484) 476-3391
(866) 848-9001
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
MD038380L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000150649
BLUE SHIELD
PA
01
—
0245761000
KEYSTONE HEALTH PLAN EAST
PA
01
—
2512748
AETNA
PA
01
—
30034459
KEYSTON MERCY HEALTH
PA
01
—
CH4023
RR MEDICARE
PA
Enumeration date
01/25/2007
Last updated
01/14/2021
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