1861632358 NPI number — ELLEN J MATHER PHYSICAL THERAPIST A

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 1861632358 NPI number — ELLEN J MATHER PHYSICAL THERAPIST A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATHER
Provider First Name:
ELLEN
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHYSICAL THERAPIST A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1861632358
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
232 LAUREL HEIGHTS DR.
Provider Second Line Business Mailing Address:
BLDG #4
Provider Business Mailing Address City Name:
BRIDGETON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08302-3634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-455-9730
Provider Business Mailing Address Fax Number:
856-455-5165

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2848 S. DELSEA DR.
Provider Second Line Business Practice Location Address:
BLDG #3
Provider Business Practice Location Address City Name:
VINELAND
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08360-7042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-696-0404
Provider Business Practice Location Address Fax Number:
856-696-8555
Provider Enumeration Date:
02/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225200000X , with the licence number:  40QB00076900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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