Provider Demographics
NPI:1598079691
Name:STAR PHYSICAL THERAPY
Entity Type:Organization
Organization Name:STAR PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPAULIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:856-608-7733
Mailing Address - Street 1:127 ARK RD
Mailing Address - Street 2:SUITE 23
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-6302
Mailing Address - Country:US
Mailing Address - Phone:856-608-7733
Mailing Address - Fax:856-608-7750
Practice Address - Street 1:127 ARK RD
Practice Address - Street 2:SUITE 23
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-6302
Practice Address - Country:US
Practice Address - Phone:856-608-7733
Practice Address - Fax:856-608-7750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01360800174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty