Healthcare Provider Details

I. General information

NPI: 1023108883
Provider Name (Legal Business Name): TRAINING ROOM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 MARLTON PIKE E
CHERRY HILL NJ
08003-1279
US

IV. Provider business mailing address

2005 MARLTON PIKE E
CHERRY HILL NJ
08003-1279
US

V. Phone/Fax

Practice location:
  • Phone: 856-874-1166
  • Fax:
Mailing address:
  • Phone: 856-874-1166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA010432
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMANDA J HUGGARD
Title or Position: OWNER
Credential: PT
Phone: 856-874-1166