MEDICARE: PREMIER PHYSICAL THERAPY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center		NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0531687	OTHER	NJ	AETNA

General Provider Information

NPI Number	:	1578599106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	300 A PRINCETON HIGHTSTOWN RD
Second Line	:	SUITE 201
City	:	EAST WINDSOR
State	:	NJ
Zip	:	08520-1411
Country	:	US
Telephone Number	:	609-426-4442
Fax Number	:	609-443-0910

Provider Business Practice Location Address
First Line	:	300 A PRINCETON HIGHTSTOWN RD
Second Line	:	SUITE 201
City	:	EAST WINDSOR
State	:	NJ
Zip	:	08520-1411
Country	:	US
Telephone Number	:	609-426-4442
Fax Number	:	609-443-0910

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. DELORES A DELEEUW
Credential	:
Telephone Number	:	609-426-4442

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	06/28/2013

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