Basic Information
| Provider Information | |||||||||
| NPI: | 1205387248 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VALENTE PROPERTIES LLC | ||||||||
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| OtherOrganizationName: | WPT SPECIALTY CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 84 E GRANT ST | ||||||||
| Address2: | SUITE #2 | ||||||||
| City: | WOODSTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080981400 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 84 E GRANT ST | ||||||||
| Address2: | SUITE #2 | ||||||||
| City: | WOODSTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080981400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567694564 | ||||||||
| FaxNumber: | 8567694637 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2016 | ||||||||
| LastUpdateDate: | 10/14/2016 | ||||||||
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| AuthorizedOfficialLastName: | VALENTE | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8567694564 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Dietary & Nutritional Service Providers | Dietitian, Registered | 225100000X | 40QA00312300 | NJ | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.