Provider Demographics
NPI:1205857497
Name:PINNACLE THERAPY SERVICES P.C.
Entity Type:Organization
Organization Name:PINNACLE THERAPY SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:DEDUFOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:609-896-4128
Mailing Address - Street 1:3131 PRINCETON PIKE
Mailing Address - Street 2:BLDG 4, SUITE 100
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2201
Mailing Address - Country:US
Mailing Address - Phone:609-896-4128
Mailing Address - Fax:609-896-0962
Practice Address - Street 1:3131 PRINCETON PIKE
Practice Address - Street 2:BLDG 4, SUITE 100
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2201
Practice Address - Country:US
Practice Address - Phone:609-896-4128
Practice Address - Fax:609-896-0962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA044205PKUMedicare PIN
NJ051498Medicare PIN