1619100435 NPI number — PROFESSIONAL THERAPY SERVICES, LLC

Table of content: (NPI 1619100435)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619100435 NPI number — PROFESSIONAL THERAPY SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROFESSIONAL THERAPY SERVICES, 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:
6
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:
1619100435
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 S BROADWAY
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
PENNSVILLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08070-2038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-678-4701
Provider Business Mailing Address Fax Number:
856-678-4702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 CAROLINE CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PILESGROVE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08098-2741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-769-1049
Provider Business Practice Location Address Fax Number:
856-769-1049
Provider Enumeration Date:
08/27/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MARINI
Authorized Official First Name:
GERALDINE
Authorized Official Middle Name:
HEALY
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
856-678-4701

Provider Taxonomy Codes

  • Taxonomy code: 225XP0200X , with the licence number:  46TR001115 , 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)





Copyright © 2007-2025 www.npivalidator.com