Paoli Sports Medicine and Rehabilitation Center, Inc.

Primary specialty

SpecialistTaxonomy code 174400000X

License

PT-000620-E Issued in PA

Legal business name

PAOLI SPORTS MEDICINE AND REHABILITATION CENTER, INC.

Practice address

30 S Valley Rd
Suite 102
Paoli, PA 19301-1469

Phone

(610) 647-1996

Fax

(610) 408-8677

NPI assigned

Oct 23, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Joseph Michael Corcoran, PT

Title

Owner

Phone

(610) 647-1996

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377561600000",
    "number": "1063595007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 S VALLEY RD",
            "address_2": "SUITE 102",
            "city": "PAOLI",
            "state": "PA",
            "postal_code": "193011450",
            "telephone_number": "610-647-1996",
            "fax_number": "610-408-8677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 S VALLEY RD",
            "address_2": "SUITE 102",
            "city": "PAOLI",
            "state": "PA",
            "postal_code": "193011469",
            "telephone_number": "610-647-1996",
            "fax_number": "610-408-8677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAOLI SPORTS MEDICINE AND REHABILITATION CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2013-08-27",
        "status": "A",
        "authorized_official_last_name": "CORCORAN",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "610-647-1996",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "PA",
            "license": "PT-000620-E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME NUMBER",
            "identifier": "1173150001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA ID NUMBER",
            "identifier": "8495471",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE NUMBER",
            "identifier": "DB4763",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paoli Pediatrics PC
• Paoli Pharmacy Inc.
• Paoli Pharmacy Inc.
• Paoli Psychological Associates
• Paoli Smiles PC
• Paoli Surgery Center LLC
• Summer Paolone, CRNP
• Paramount Counseling Center LLC
• Yoon Hee Park
• Debbie Parnes, D.M.D.

• Specialist in Paoli, PA
• Providers in Paoli, PA by specialty
• Specialist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.