PROACTIVE PHYSICAL MEDICINE, LLC (NPI# 1437349131) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1437349131 |
| Entity Type | Organization |
| Organization Name | PROACTIVE PHYSICAL MEDICINE, LLC |
| Practice Address |
1331 E Wyoming Ave Suite 1100 Philadelphia PA 19124-3808 |
| Practice Telephone | 2157444030 |
| Practice Fax Number | 2157444582 |
| Mailing Telephone | 2157444030 |
| Mailing Fax Number | 2157444582 |
| Enumeration Date | 2007-07-29 |
| Last Update Date | 2009-09-01 |
| Authorized Official Name | AILEEN QUELL (BILLING MANAGER) |
| Authorized Official Telephone | 2153213538 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
Ambulatory Health Care Facilities |
| Street Address |
1331 E WYOMING AVE SUITE 1100 |
| City | PHILADELPHIA |
| State | PA |
| Zip Code | 19124-3808 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154893303 | Jacqueline Sweeney | Nurse Practitioner | 1331 E Wyoming Ave, Philadelphia, PA 19124-3808 | 2018-12-28 |
| 1477025096 | Renee Pieroth | Dietitian, Registered | 1331 E Wyoming Ave, Philadelphia, PA 19124-3808 | 2018-12-20 |
| 1184109399 | Stephanie Maria Einstein | Nurse Practitioner | 1331 E Wyoming Ave, Philadelphia, PA 19124-3808 | 2018-10-03 |
| 1346735149 | Kamorin Samson | Dietitian, Registered | 1331 E Wyoming Ave, Philadelphia, PA 19124-3808 | 2018-06-25 |
| 1962802819 | Jennifer Lynn Jones | Physician Assistant | 1331 E Wyoming Ave, Philadelphia, PA 19124-3808 | 2014-08-28 |
| 1649607284 | Audrey Lynn Shaw | Physician Assistant | 1331 E Wyoming Ave, Philadelphia, PA 19124-3808 | 2013-09-27 |
| 1427481209 | Rocco Michael Bianco IIi | Registered Nurse | 1331 E Wyoming Ave, Philadelphia, PA 19124-3808 | 2013-08-15 |
| 1912349556 | Catherine Kirby Lee | Registered Nurse | 1331 E Wyoming Ave, Philadelphia, PA 19124-3808 | 2013-07-24 |
| 1932547742 | Xiao Yang | Internal Medicine | 1331 E Wyoming Ave, Philadelphia, PA 19124-3808 | 2013-06-13 |
| 1083052435 | Carol F Roth | Social Worker | 1331 E Wyoming Ave, Philadelphia, PA 19124-3808 | 2013-06-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831749308 | William Mark Hanna Sr. | Pharmacist | 4600 Rooselvelt Blvd Bldg G, Philadelphia, PA 19124 | 2019-09-17 |
| 1881256451 | Medical Discovery Systems, LLC | Durable Medical Equipment & Medical Supplies | 5425 Oxford Ave., 5425 Oxford Ave. Suite (3 A), Philadelphia, PA 19124 | 2019-07-03 |
| 1548731391 | Sierra Pinkney | Registered Nurse | 1615 Granite St, Philadelphia, PA 19124 | 2018-12-05 |
| 1922507987 | Xavier Sergio Henriquez | Counselor | 4510 Frankford Avenue 2nd Floor, Philadelphia, PA 19124 | 2018-02-06 |
| 1558881581 | Isabel Cristina Castillo Hernandez | Pediatrics | 4500-10, Apt 201b, Philadelphia, PA 19124 | 2017-06-21 |
| 1952843732 | Patrick Grugan | Social Worker | Roosevelt Boulevard & Adams Avenue, Philadelphia, PA 19124 | 2016-11-10 |
| 1811340482 | Katarzyna Liwski | Psychiatry & Neurology | 4641 Roosevelt Boulevard, E212, Drexel University College of Medicine Friends Hospital, Philadelphia, PA 19124 | 2016-07-19 |
| 1851769327 | Aleka Kostouros | Social Worker | Roosevelt Blvd & Adams Ave, Northeast Community Center for Behavioral Health, Philadelphia, PA 19124 | 2015-09-14 |
| 1407230378 | Sara Bachani | Psychiatry & Neurology | 4641 Roosevelt Blvd, Friends Hospital, Room 231, Philadelphia, PA 19124 | 2015-07-10 |
| 1215327051 | Alyssa Renee Kirk | Counselor | 4500-10 Frankford Ave, 2nd Floor, Philadelphia, PA 19124 | 2015-02-02 |
| Find all providers in zip 19124 | ||||
| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992273890 | Sandpipermd, Inc. | Clinic/Center | 407 S 10th St Fl 2, Philadelphia, PA 19147-1274 | 2018-11-08 |
| 1962872861 | Mb Integrative Medicine LLC | Clinic/Center | 6782 Germantown Ave, Philadelphia, PA 19119-2110 | 2015-10-05 |
| 1255695334 | Flat Rock Health Medical Associates | Clinic/Center | 4026 Main St, Philadelphia, PA 19127-2112 | 2012-07-03 |
| 1164663050 | Rittenhouse Plastic Surgery, P.C. | Clinic/Center | 255 S 17th St Ste 2200, Medical Tower Building, Philadelphia, PA 19103-6221 | 2009-03-23 |
| 1326188970 | Philadelphia Va Medica Center | Clinic/Center | Padrecc, Philadelphia Va Medical Center, University and Woodland Avenue, Philadelphia, PA 19104 | 2007-02-06 |
| 1588107668 | Bustleton Healthcare | Clinic/Center | 9867 Bustleton Ave, Suite B, Philadelphia, PA 19115-2611 | 2016-11-22 |
| 1265983753 | Victoria Consulting Services, Inc | Clinic/Center | 9922 Roosevelt Blvd, Philadelphia, PA 19115-1705 | 2016-10-19 |
| 1669868725 | Philly As, LLC | Clinic/Center | 1500 Jfk Blvd, Ste 301, Philadelphia, PA 19102-1710 | 2015-04-15 |
| 1588973291 | Romeo S. Abella Md PC | Clinic/Center | 915 E Cayuga St, Philadelphia, PA 19124-3817 | 2010-09-29 |
| 1710200928 | Karen E. Agersbog, D.o. Associates, P.C. | Clinic/Center | 8815 Germantown Ave, Suite 14, Philadelphia, PA 19118-2722 | 2010-03-03 |
| Find all providers in PHILADELPHIA | ||||
| City | PHILADELPHIA |
| Zip Code | 19124 |
Please comment or provide details below to improve the information on PROACTIVE PHYSICAL MEDICINE, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.