Basic Information
| Provider Information | |||||||||
| NPI: | 1578048054 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRANSFORM REHABILITATION, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3722 LEHIGH ST STE 406 | ||||||||
| Address2: | |||||||||
| City: | WHITEHALL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180523439 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3722 LEHIGH ST STE 406 | ||||||||
| Address2: | |||||||||
| City: | WHITEHALL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180523439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105942060 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2018 | ||||||||
| LastUpdateDate: | 11/12/2018 | ||||||||
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| AuthorizedOfficialLastName: | LANCE | ||||||||
| AuthorizedOfficialFirstName: | KYLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 6105942060 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT, DPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.