Provider Demographics
NPI:1699822015
Name:PHYSICAL SOLUTIONS LLC
Entity Type:Organization
Organization Name:PHYSICAL SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-751-8881
Mailing Address - Street 1:805 COOPER ROAD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4305
Mailing Address - Country:US
Mailing Address - Phone:856-751-8881
Mailing Address - Fax:856-751-8810
Practice Address - Street 1:805 COOPER ROAD
Practice Address - Street 2:SUITE 6
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4305
Practice Address - Country:US
Practice Address - Phone:856-751-8881
Practice Address - Fax:856-751-8810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NJ40QA0696300225100000X
NJ40QA00982700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTAX ID