Healthcare Provider Details

I. General information

NPI: 1407068687
Provider Name (Legal Business Name): HAMMONTON ORTHOPEDIC AND SPORTS PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 WHITE HORSE PIKE
ATCO NJ
08004-2257
US

IV. Provider business mailing address

289 WHITE HORSE PIKE
ATCO NJ
08004-2257
US

V. Phone/Fax

Practice location:
  • Phone: 856-753-5523
  • Fax: 609-704-9054
Mailing address:
  • Phone: 856-753-5523
  • Fax: 609-704-9054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MARK CALABRIA
Title or Position: DIRECTOR
Credential: PT
Phone: 609-704-1980