Provider Demographics
NPI:1447305776
Name:LOWER MERION REHABILITATION
Entity type:Organization
Organization Name:LOWER MERION REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEBAKKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:844-476-3391
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-0457
Mailing Address - Country:US
Mailing Address - Phone:484-476-3391
Mailing Address - Fax:866-848-9001
Practice Address - Street 1:100 E LANCASTER AVE STE B7
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:484-476-3391
Practice Address - Fax:866-848-9001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038380L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30034459OtherKEYSTON MERCY HEALTH
PA2512748OtherAETNA
PACH4023OtherRR MEDICARE
PA0245761000OtherKEYSTONE HEALTH PLAN EAST
PA000150649OtherBLUE SHIELD
PA30034459OtherKEYSTON MERCY HEALTH