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General NPI Number Information
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NPI Number | 1205169943
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Entity Type | Organization
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Legal Business Name | SPORTS MEDICINE SOLUTIONS
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Dates
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Enumeration Date | 09/14/2009
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Last Update Date | 09/14/2009
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Provider Practice Location Address
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Address Line | 1250 CHEWS LANDING RD
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City | LAUREL SPRINGS
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State | NJ
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Zip | 08021-2816
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Country | US
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Telephone | 856-566-4400
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Fax | 856-566-4447
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Provider Business Mailing Address
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Address Line | 1250 CHEWS LANDING RD
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City | LAUREL SPRINGS
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State | NJ
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Zip | 08021-2816
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Country | US
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Telephone | 856-566-4400
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Fax | 856-566-4447
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MRS. MARYANNE K. CAREY
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Credential |
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Telephone | 856-566-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40Q00523300
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License Number State | NJ
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