=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043312127
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STAR PHYSICAL THERAPY P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 176 ROUTE 70 SUITE 10
-----------------------------------------------------
City | MEDFORD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08055-8704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-714-7733
-----------------------------------------------------
Fax | 609-714-7750
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 176 ROUTE 70 SUITE 10
-----------------------------------------------------
City | MEDFORD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08055-8704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-714-7733
-----------------------------------------------------
Fax | 609-714-7750
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PT OFFICE MANAGER
-----------------------------------------------------
Name | MR. JOSEPH M MOORE
-----------------------------------------------------
Credential | MPT
-----------------------------------------------------
Telephone | 609-714-7733
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------