Basic Information
| Provider Information | |||||||||
| NPI: | 1598079691 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STAR PHYSICAL THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 127 ARK RD | ||||||||
| Address2: | SUITE 23 | ||||||||
| City: | MOUNT LAUREL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080546302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566087733 | ||||||||
| FaxNumber: | 8566087750 | ||||||||
| Practice Location | |||||||||
| Address1: | 127 ARK RD | ||||||||
| Address2: | SUITE 23 | ||||||||
| City: | MOUNT LAUREL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080546302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566087733 | ||||||||
| FaxNumber: | 8566087750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2010 | ||||||||
| LastUpdateDate: | 07/30/2010 | ||||||||
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| AuthorizedOfficialLastName: | DEPAULIS | ||||||||
| AuthorizedOfficialFirstName: | TOM | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8566087733 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MSPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 40QA01360800 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.