Healthcare Provider Details

I. General information

NPI: 1669428264
Provider Name (Legal Business Name): CROWN THERAPISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VILLAGE DR
CAPE MAY COURT HOUSE NJ
08210-1939
US

IV. Provider business mailing address

1 VILLAGE DR PO BOX 874
CAPE MAY COURT HOUSE NJ
08210-1939
US

V. Phone/Fax

Practice location:
  • Phone: 609-463-8107
  • Fax: 609-463-9540
Mailing address:
  • Phone: 609-463-8107
  • Fax: 609-463-9540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00466300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR00220900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberNONE
License Number StateNJ

VIII. Authorized Official

Name: MR. STEVEN AIGBOGUN
Title or Position: PRESIDENT
Credential: RPT
Phone: 609-463-9553