Provider Demographics
NPI:1508198698
Name:CHILDRENS THERAPY SOURCE
Entity Type:Organization
Organization Name:CHILDRENS THERAPY SOURCE
Other - Org Name:EILEEN RYAN KURTZ
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN KURTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:732-356-7154
Mailing Address - Street 1:14 WORLDS FAIR DRIVE
Mailing Address - Street 2:SUITE M
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873
Mailing Address - Country:US
Mailing Address - Phone:732-356-7154
Mailing Address - Fax:732-356-5364
Practice Address - Street 1:14 WORLDS FAIR DRIVE
Practice Address - Street 2:SUITE M
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873
Practice Address - Country:US
Practice Address - Phone:732-356-7154
Practice Address - Fax:732-356-5364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00509400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty