Healthcare Provider Details

I. General information

NPI: 1497899330
Provider Name (Legal Business Name): BREAST CANCER PHYSICAL THERAPY CENTER, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 03/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 W ORMOND AVE SUITE 2
CHERRY HILL NJ
08002-3041
US

IV. Provider business mailing address

13 W ORMOND AVE SUITE 2
CHERRY HILL NJ
08002-3041
US

V. Phone/Fax

Practice location:
  • Phone: 856-429-8200
  • Fax: 856-429-2260
Mailing address:
  • Phone: 856-429-8200
  • Fax: 856-429-2260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT006405L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number40Q00667300
License Number StateNJ

VIII. Authorized Official

Name: LINDA T MILLER
Title or Position: CLINCAL DIRECTOR, PRESIDENT
Credential: PT, DPT
Phone: 856-429-8200