=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497820658
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRISM PHYSICAL THERAPY, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2006
-----------------------------------------------------
Last Update Date | 11/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1245 WHITEHORSE MERCERVILLE RD SUITE 407
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08619-3831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-581-7550
-----------------------------------------------------
Fax | 609-581-7552
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1245 WHITEHORSE MERCERVILLE RD SUITE 407
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08619-3831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-581-7550
-----------------------------------------------------
Fax | 609-581-7552
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. RICHARD P FRISCIA
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 609-581-7550
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number | 40QA00302000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------