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General NPI Number Information
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NPI Number | 1205950581
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Entity Type | Organization
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Legal Business Name | SAM'S KIDS PEDIATRIC THERAPY
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 05/30/2015
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Provider Practice Location Address
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Address Line | 604 LYNDA RD
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City | PHILLIPSBURG
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State | NJ
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Zip | 08865-1743
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Country | US
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Telephone | 908-454-8687
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Fax | 908-454-6279
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Provider Business Mailing Address
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Address Line | 604 LYNDA RD
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City | PHILLIPSBURG
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State | NJ
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Zip | 08865-1743
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Country | US
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Telephone | 908-454-8687
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Fax | 908-454-6279
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. DEBORAH JOY MARKLE
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Credential | P.T.
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Telephone | 908-454-8687
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 40QA00217000
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License Number State | NJ
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