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General NPI Number Information
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NPI Number | 1598079691
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Entity Type | Organization
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Legal Business Name | STAR PHYSICAL THERAPY
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Dates
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Enumeration Date | 07/30/2010
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Last Update Date | 07/30/2010
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Provider Practice Location Address
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Address Line | 127 ARK RD SUITE 23
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City | MOUNT LAUREL
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State | NJ
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Zip | 08054-6302
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Country | US
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Telephone | 856-608-7733
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Fax | 856-608-7750
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Provider Business Mailing Address
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Address Line | 127 ARK RD SUITE 23
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City | MOUNT LAUREL
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State | NJ
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Zip | 08054-6302
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Country | US
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Telephone | 856-608-7733
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Fax | 856-608-7750
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Authorized Official
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Title or Position | OWNER
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Name | TOM DEPAULIS
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Credential | MSPT
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Telephone | 856-608-7733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 40QA01360800
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License Number State | NJ
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