Organization
INTEGRATED MEDICAL CARE, LLC
Active
Other names
Aquatic Rehabilitation & Physical Therapy Center
Organization subpart
No
Provider details
NPI number
Authorized official
NATALYA MATYASHOVA (COORDINATOR)
(215) 742-7033
Entity
Organization
Contact information
Practice address
15501 BUSTLETON AVE, SUITE A, PHILADELPHIA, PA 19116-1187
(215) 742-7033
(215) 742-7034
Mailing address
15501 BUSTLETON AVE, SUITE A, PHILADELPHIA, PA 19116-1187
(215) 742-7033
(215) 742-7034
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
225100000X
Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0019445460004
—
PA
Enumeration date
06/21/2006
Last updated
03/10/2017
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