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General NPI Number Information
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NPI Number | 1861632358
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Entity Type | Individual
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Provider Name | ELLEN J MATHER PHYSICAL THERAPIST A
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Gender | Female
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Dates
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Enumeration Date | 02/24/2009
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Last Update Date | 02/24/2009
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Provider Practice Location Address
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Address Line | 2848 S. DELSEA DR. BLDG #3
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City | VINELAND
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State | NJ
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Zip | 08360-7042
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Country | US
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Telephone | 856-696-0404
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Fax | 856-696-8555
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Provider Business Mailing Address
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Address Line | 232 LAUREL HEIGHTS DR. BLDG #4
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City | BRIDGETON
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State | NJ
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Zip | 08302-3634
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Country | US
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Telephone | 856-455-9730
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Fax | 856-455-5165
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 40QB00076900
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License Number State | NJ
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