Provider Demographics
NPI:1376601930
Name:WEST WINDSOR-PLAINSBORO PHYSICAL THERAPY CENTER, LLC
Entity Type:Organization
Organization Name:WEST WINDSOR-PLAINSBORO PHYSICAL THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:EDGERLY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:690-275-0666
Mailing Address - Street 1:666 PLAINSBORO RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-3004
Mailing Address - Country:US
Mailing Address - Phone:690-275-0666
Mailing Address - Fax:609-275-8004
Practice Address - Street 1:666 PLAINSBORO RD
Practice Address - Street 2:SUITE 240
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536-3004
Practice Address - Country:US
Practice Address - Phone:690-275-0666
Practice Address - Fax:609-275-8004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00527200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ804615OtherAETNA
NJ804615OtherAETNA
NJ=========OtherUNITED HEALTHCARE
NJ804615OtherAETNA