Provider Demographics
NPI:1326291105
Name:ENVISION REHABILITATION
Entity Type:Organization
Organization Name:ENVISION REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PIMPINELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-340-3301
Mailing Address - Street 1:1625 CHARTER OAK AVE
Mailing Address - Street 2:
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-5007
Mailing Address - Country:US
Mailing Address - Phone:856-340-3301
Mailing Address - Fax:
Practice Address - Street 1:860 ROUTE 168
Practice Address - Street 2:SUITE 106
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-3215
Practice Address - Country:US
Practice Address - Phone:856-340-3301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00854100261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy