MEDICARE: EGG HARBOR TOWNSHIP PHYSICAL THERAPY & PAIN RELIEF LLC

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	:	1679619258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EGG HARBOR TOWNSHIP PHYSICAL THERAPY & PAIN RELIEF LLC

Provider Business Mailing Address
First Line	:	PO BOX 359
Second Line	:
City	:	GOSHEN
State	:	NY
Zip	:	10924-0359
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3007 OCEAN HEIGHTS AVE
Second Line	:	SUITE 101 &102
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-7707
Country	:	US
Telephone Number	:	609-601-9555
Fax Number	:	609-601-9551

Authorized Official
Title or Position	:	CO-OWNER
Name	:	CHRISTOPHER J ALBANESE
Credential	:	PT
Telephone Number	:	845-615-1585

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	04/14/2008

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