Healthcare Provider Details

I. General information

NPI: 1154625721
Provider Name (Legal Business Name): WOODSTOWN PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2010
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 E GRANT ST
WOODSTOWN NJ
08098-1400
US

IV. Provider business mailing address

84 E GRANT ST SUITE 3
WOODSTOWN NJ
08098-1400
US

V. Phone/Fax

Practice location:
  • Phone: 856-769-4564
  • Fax: 856-769-4637
Mailing address:
  • Phone: 856-769-4564
  • Fax: 856-769-4637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARK L VALENTE
Title or Position: PRESIDENT
Credential:
Phone: 856-769-4564