Provider Demographics
NPI:1346296860
Name:ARCHBALD, CHARLES E III (PT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:ARCHBALD
Suffix:III
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08501-1914
Mailing Address - Country:US
Mailing Address - Phone:609-259-5394
Mailing Address - Fax:
Practice Address - Street 1:1900 ARENA DR
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08610-2409
Practice Address - Country:US
Practice Address - Phone:609-585-2333
Practice Address - Fax:609-585-6522
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01019800225100000X
NJ40QA01049800174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ094278PYAMedicare UPIN
NJ049454Medicare ID - Type Unspecified