Provider Demographics
NPI:1134529118
Name:THE FALL PREVENTION GROUP, LLC
Entity type:Organization
Organization Name:THE FALL PREVENTION GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRAY-MICELI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, GNP-BC
Authorized Official - Phone:609-790-2327
Mailing Address - Street 1:230 N MAPLE AVE STE B1
Mailing Address - Street 2:# 284
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-9412
Mailing Address - Country:US
Mailing Address - Phone:609-790-2327
Mailing Address - Fax:
Practice Address - Street 1:4401 HAVERFORD AVE # 19104
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-1332
Practice Address - Country:US
Practice Address - Phone:215-349-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty