NPIMap

Organization Active NPI

Olympic Rehabilitation and Aquatic Center

  • Specialist
  • Philadelphia, PA
National Provider Identifier
1972658003
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
PT-002109-E Issued in PA
Legal business name
OLYMPIC REHABILITATION AND AQUATIC CENTER
Practice address
11040 Rennard St
Philadelphia, PA 19116-2618
Phone
(215) 671-8909
Fax
(215) 671-0686
NPI assigned
Jan 25, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Alex Ufberg, L.P.T.
Title
Licensed Physical Therapist
Phone
(215) 671-8909

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X PT-002109-E PA Primary

Addresses

Primary practice location

11040 Rennard St
Philadelphia, PA 19116-2618

Mailing address

11040 Rennard St
Philadelphia, PA 19116-2618
Phone (215) 671-8909

National Provider Directory

National Provider Directory
Tax ID family
Northeast Adult Day Care Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

11040 Rennard St
Philadelphia, PA 19116
Phone (215) 275-0897

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972658003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11040 RENNARD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191162618",
            "telephone_number": "215-671-8909",
            "fax_number": "215-671-0686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11040 RENNARD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191162618",
            "telephone_number": "215-671-8909",
            "fax_number": "215-671-0686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLYMPIC REHABILITATION AND AQUATIC CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "UFBERG",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "LICENSED PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "215-671-8909",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "L.P.T."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "PA",
            "license": "PT-002109-E",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.