Healthcare Provider Details

I. General information

NPI: 1801879457
Provider Name (Legal Business Name): CENTER FOR ORTHOPEDIC & SPINE PHYSICALTHERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 05/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CADILLAC RD
BURLINGTON NJ
08016-4815
US

IV. Provider business mailing address

22 WOODSTONE LN UNIT A
BURLINGTON TOWNSHIP NJ
08016-4333
US

V. Phone/Fax

Practice location:
  • Phone: 609-880-0880
  • Fax: 609-227-4423
Mailing address:
  • Phone: 609-721-1492
  • Fax: 609-227-4423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LAWRENCE SEGUI RAMISCAL
Title or Position: OWNER
Credential: PT,DPT, OCS,FAAOMPT
Phone: 609-721-1492