Provider Demographics
NPI:1407283351
Name:ASPEN PT CENTERS LLC
Entity Type:Organization
Organization Name:ASPEN PT CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-881-5800
Mailing Address - Street 1:PO BOX 179
Mailing Address - Street 2:
Mailing Address - City:PITMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08071-0179
Mailing Address - Country:US
Mailing Address - Phone:856-881-5800
Mailing Address - Fax:856-881-3511
Practice Address - Street 1:601 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-1637
Practice Address - Country:US
Practice Address - Phone:856-881-5800
Practice Address - Fax:856-881-3511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-08
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0400603982261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy