=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639371875
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HIGHWAY TO FITNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14 PARKE PLACE BLVD SUITE D
-----------------------------------------------------
City | SEWELL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08080-2661
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-440-0497
-----------------------------------------------------
Fax | 856-256-8390
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 PARKE PLACE BLVD SUITE D
-----------------------------------------------------
City | SEWELL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08080-2661
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-440-0497
-----------------------------------------------------
Fax | 856-256-8390
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. JANET L. BILLY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 609-440-0497
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 40QA00489700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------