Provider Demographics
NPI:1295822401
Name:SPECTRUM REHABILITATION LLC
Entity Type:Organization
Organization Name:SPECTRUM REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCORDO
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:609-226-8037
Mailing Address - Street 1:67 HIGBEE AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2323
Mailing Address - Country:US
Mailing Address - Phone:609-226-8037
Mailing Address - Fax:609-653-1258
Practice Address - Street 1:67 HIGBEE AVE
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2323
Practice Address - Country:US
Practice Address - Phone:609-226-8037
Practice Address - Fax:609-653-1258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA06574225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1598789273OtherJOSEPH BONZEK NPI NUMBER
NJ1992729677OtherPETE SCORDO NPI NUMBER
NJ066929Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER