1003118886 NPI number — AMELIA NELSON BS PT LLC

Table of content: (NPI 1003118886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003118886 NPI number — AMELIA NELSON BS PT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMELIA NELSON BS PT LLC
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:
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:
1003118886
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1869 GREENTREE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHERRY HILL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08003-2009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-424-2444
Provider Business Mailing Address Fax Number:
856-424-8632

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1869 GREENTREE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHERRY HILL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08003-2009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-424-2444
Provider Business Practice Location Address Fax Number:
856-424-8632
Provider Enumeration Date:
11/29/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NELSON
Authorized Official First Name:
AMELIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICAL THERAPIST/OWNER
Authorized Official Telephone Number:
856-424-2444

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  40QA00242000 , 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)

  • Identifier: 545105 . This is a "MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1417033309 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".