Basic Information
| Provider Information | |||||||||
| NPI: | 1386074573 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DOCTOR PHYSICAL THERAPY II, LLC | ||||||||
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| OtherOrganizationName: | DOCTOR PHYSICAL THERAPY LLC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 MANTUA PIKE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | WEST DEPTFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565797201 | ||||||||
| FaxNumber: | 8565797734 | ||||||||
| Practice Location | |||||||||
| Address1: | 711B MANTUA PIKE | ||||||||
| Address2: | |||||||||
| City: | WEST DEPTFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565797201 | ||||||||
| FaxNumber: | 8565797734 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2013 | ||||||||
| LastUpdateDate: | 07/11/2018 | ||||||||
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| AuthorizedOfficialLastName: | SCOTT | ||||||||
| AuthorizedOfficialFirstName: | MONICA | ||||||||
| AuthorizedOfficialMiddleName: | JANEL | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4122872667 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | N | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | 225100000X | 40QA01478500 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.