Basic Information
| Provider Information | |||||||||
| NPI: | 1477009322 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | S & H REHABILITATION ASSOC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | INTEGRITY PHYSICAL THERAPY AND WELLNESS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 RAMS GATE COURT | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094421212 | ||||||||
| FaxNumber: | 6092416348 | ||||||||
| Practice Location | |||||||||
| Address1: | 331 TILTON RD SUITE 7 | ||||||||
| Address2: | |||||||||
| City: | NORTHFIELD | ||||||||
| State: | ATLANTIC COUNTY | ||||||||
| PostalCode: | 08225 | ||||||||
| CountryCode: | UM | ||||||||
| TelephoneNumber: | 6092416348 | ||||||||
| FaxNumber: | 6092416348 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2016 | ||||||||
| LastUpdateDate: | 08/31/2016 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialFirstName: | RUDOLPH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6094421212 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
| AuthorizedOfficialCredential: | PT . MPT | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 40QA01670400 | NJ | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.