=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861428310
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A.C. PHYSICAL THERAPY SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2006
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2406 NEW RD
-----------------------------------------------------
City | NORTHFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08225-1409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-645-2224
-----------------------------------------------------
Fax | 609-646-0609
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2406 NEW RD
-----------------------------------------------------
City | NORTHFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08225-1409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-645-2224
-----------------------------------------------------
Fax | 609-646-0609
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. LIAQAT SHAZAD
-----------------------------------------------------
Credential | PHYSICAL THERAPIST
-----------------------------------------------------
Telephone | 609-645-2224
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 40QA00361700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------