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General NPI Number Information
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NPI Number | 1295822401
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Entity Type | Organization
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Legal Business Name | SPECTRUM REHABILITATION LLC
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Dates
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Enumeration Date | 10/07/2006
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 2300 NEW RD
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City | NORTHFIELD
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State | NJ
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Zip | 08225
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Country | US
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Telephone | 609-226-8037
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Fax | 609-383-8340
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Provider Business Mailing Address
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Address Line | 2300 NEW RD
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City | NORTHFIELD
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State | NJ
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Zip | 08225-1466
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Country | US
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Telephone | 609-204-4849
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Fax | 609-383-8340
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Authorized Official
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Title or Position | OWNER
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Name | PETE SCORDO
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Credential | MPT
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Telephone | 609-226-8037
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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 | QA06574
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License Number State | NJ
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