1194207092 NPI number — PHYSICAL THERAPY SERVICES

Table of content: LAURA LOGAN CHAPMAN PT (NPI 1750827648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194207092 NPI number — PHYSICAL THERAPY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICAL THERAPY SERVICES
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:
1194207092
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
715 NEWARK POMPTON TPKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POMPTON PLAINS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07444-1330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-835-6115
Provider Business Mailing Address Fax Number:
973-835-6861

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
715 NEWARK POMPTON TPKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POMPTON PLAINS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07444-1330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-835-6115
Provider Business Practice Location Address Fax Number:
973-835-6861
Provider Enumeration Date:
09/06/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BABLER
Authorized Official First Name:
TRACEY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
973-835-6115

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)