Provider Demographics
NPI:1275229809
Name:INNER CIRCLE PHYSICAL THERAPY & WELLNESS
Entity Type:Organization
Organization Name:INNER CIRCLE PHYSICAL THERAPY & WELLNESS
Other - Org Name:SKYLAND PELVIC REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:908-257-0602
Mailing Address - Street 1:8 COLONIAL CT
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NJ
Mailing Address - Zip Code:08833-4100
Mailing Address - Country:US
Mailing Address - Phone:908-257-0602
Mailing Address - Fax:
Practice Address - Street 1:8 COLONIAL CT
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NJ
Practice Address - Zip Code:08833-4100
Practice Address - Country:US
Practice Address - Phone:908-257-0602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-17
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty