1821160250 NPI number — SPORTS PHYSICAL THERAPY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821160250 NPI number — SPORTS PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPORTS PHYSICAL THERAPY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SPORTS PHYSICAL THERAPY HILLSBOROUGH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821160250
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 310
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THREE BRIDGES
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08887-0310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-806-2645
Provider Business Mailing Address Fax Number:
908-806-5228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 TRIANGLE ROAD
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
HILLSBOROUGH
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-369-8850
Provider Business Practice Location Address Fax Number:
908-369-8895
Provider Enumeration Date:
11/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BORER
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
DIRECTOR PHYSICAL THERAPIST
Authorized Official Telephone Number:
908-369-8850

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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