MEDICARE: POSITIVE IMPACT PHYSICAL THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1144185687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POSITIVE IMPACT PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	PO BOX 101
Second Line	:
City	:	STONE HARBOR
State	:	NJ
Zip	:	08247-0101
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1065 ROUTE 47 S
Second Line	:
City	:	RIO GRANDE
State	:	NJ
Zip	:	08242-1500
Country	:	US
Telephone Number	:	856-534-4315
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	ELIZABETH CLARK
Credential	:	DPT
Telephone Number	:	856-534-4315

Provider Enumeration Date	:	12/17/2025
Last Update Date	:	12/23/2025

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