Provider Demographics
NPI:1043312127
Name:STAR PHYSICAL THERAPY P.A.
Entity Type:Organization
Organization Name:STAR PHYSICAL THERAPY P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:609-714-7733
Mailing Address - Street 1:176 ROUTE 70
Mailing Address - Street 2:SUITE 10
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-8704
Mailing Address - Country:US
Mailing Address - Phone:609-714-7733
Mailing Address - Fax:609-714-7750
Practice Address - Street 1:176 ROUTE 70
Practice Address - Street 2:SUITE 10
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-8704
Practice Address - Country:US
Practice Address - Phone:609-714-7733
Practice Address - Fax:609-714-7750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ071827Medicare ID - Type Unspecified