Healthcare Provider Details

I. General information

NPI: 1740657964
Provider Name (Legal Business Name): STRIVE PHYSICAL THERAPY AND SPORTS REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 MARNE HWY SUITE 203
MOORESTOWN NJ
08057-3126
US

IV. Provider business mailing address

224 STRAWBRIDGE DR STE 100
MOORESTOWN NJ
08057-4602
US

V. Phone/Fax

Practice location:
  • Phone: 856-914-1400
  • Fax: 856-234-3014
Mailing address:
  • Phone: 856-677-4000
  • Fax: 856-234-3014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: PHILLIP DAWSON
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 856-677-4000