Provider Demographics
NPI:1205848843
Name:RUSHMORE PHYSICAL THERAPY, P.A.
Entity Type:Organization
Organization Name:RUSHMORE PHYSICAL THERAPY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:RUSHMORE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:856-764-0494
Mailing Address - Street 1:PO BOX 505
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-0505
Mailing Address - Country:US
Mailing Address - Phone:856-764-0494
Mailing Address - Fax:856-764-0580
Practice Address - Street 1:1361 FAIRVIEW BLVD
Practice Address - Street 2:SUITE J
Practice Address - City:DELRAN
Practice Address - State:NJ
Practice Address - Zip Code:08075-1473
Practice Address - Country:US
Practice Address - Phone:856-764-0494
Practice Address - Fax:856-764-0580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QAO0262900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA18155OtherPA BLUE SHIELD
NJ0444623000OtherAMERIHEALTH
NJ0444623000OtherAMERIHEALTH