Provider Demographics
NPI:1114081478
Name:PHYSICAL THERAPY CENTER OF PERTH AMBOY
Entity Type:Organization
Organization Name:PHYSICAL THERAPY CENTER OF PERTH AMBOY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIMISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KERI
Authorized Official - Middle Name:
Authorized Official - Last Name:FESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-697-0001
Mailing Address - Street 1:220 MARKET ST
Mailing Address - Street 2:STE.#101
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-4331
Mailing Address - Country:US
Mailing Address - Phone:732-697-0001
Mailing Address - Fax:732-697-0044
Practice Address - Street 1:220 MARKET ST
Practice Address - Street 2:STE.#101
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-4331
Practice Address - Country:US
Practice Address - Phone:732-697-0001
Practice Address - Fax:732-697-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities