Basic Information
| Provider Information | |||||||||
| NPI: | 1578599106 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PREMIER PHYSICAL THERAPY PC | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | PREMIER PHYSICAL THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 300 A PRINCETON HIGHTSTOWN RD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | EAST WINDSOR | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085201411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094264442 | ||||||||
| FaxNumber: | 6094430910 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 A PRINCETON HIGHTSTOWN RD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | EAST WINDSOR | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085201411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094264442 | ||||||||
| FaxNumber: | 6094430910 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2006 | ||||||||
| LastUpdateDate: | 06/28/2013 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DELEEUW | ||||||||
| AuthorizedOfficialFirstName: | DELORES | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6094264442 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | NJ | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
ID Information
| ID | Type | State | Issuer | Description | 0531687 | 01 | NJ | AETNA | OTHER |