1578599106 NPI number — PREMIER PHYSICAL THERAPY PC

Table of content: (NPI 1578599106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578599106 NPI number — PREMIER PHYSICAL THERAPY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER PHYSICAL THERAPY PC
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:
PREMIER PHYSICAL THERAPY
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:
1578599106
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 A PRINCETON HIGHTSTOWN RD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
EAST WINDSOR
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08520-1411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-426-4442
Provider Business Mailing Address Fax Number:
609-443-0910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 A PRINCETON HIGHTSTOWN RD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
EAST WINDSOR
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08520-1411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-426-4442
Provider Business Practice Location Address Fax Number:
609-443-0910
Provider Enumeration Date:
06/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DELEEUW
Authorized Official First Name:
DELORES
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
609-426-4442

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , 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: 0531687 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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