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NPI Code Detail

MEDICARE: ILUMINAR PHYSICAL THERAPY LLC

MEDICARE: ILUMINAR PHYSICAL THERAPY 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
1225XP0200XPediatric Occupational Therapist
22251P0200XPediatric Physical Therapist

General Provider Information

NPI Number : 1801575550
Entity Type Code : Organization
Provider Name (Legal Business Name) : ILUMINAR PHYSICAL THERAPY LLC
Provider Business Mailing Address
First Line : 105 SUMMERBROOKE CT
Second Line :
City : SICKLERVILLE
State : NJ
Zip : 08081-9685
Country : US
Telephone Number : 267-297-6499
Fax Number :
Provider Business Practice Location Address
First Line : 2000 HAMILTON ST STE 301
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19130-3874
Country : US
Telephone Number : 267-297-6499
Fax Number :
Authorized Official
Title or Position : OWNER
Name : KINDRA SCOTT
Credential : PT
Telephone Number : 267-297-6499
Provider Enumeration Date : 07/11/2023
Last Update Date : 07/13/2023

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Directions to “ILUMINAR PHYSICAL THERAPY LLC ” Practice Location

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