Provider Demographics
NPI:1437229606
Name:ORTHOPEDIC AND SPORTS PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:ORTHOPEDIC AND SPORTS PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHAN
Authorized Official - Middle Name:DIRK
Authorized Official - Last Name:VANSCHALKWYK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:856-354-5044
Mailing Address - Street 1:PO BOX 331
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-0235
Mailing Address - Country:US
Mailing Address - Phone:856-354-5044
Mailing Address - Fax:856-354-8133
Practice Address - Street 1:112 HADDONTOWNE CT
Practice Address - Street 2:SUITE 303
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-3661
Practice Address - Country:US
Practice Address - Phone:856-354-5044
Practice Address - Fax:856-354-8133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ060464Medicare UPIN