Provider Demographics
NPI:1700832706
Name:PHYSICAL THERAPY SERVICES RUTALA, INGEMI & BARBARA LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY SERVICES RUTALA, INGEMI & BARBARA LLC
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER/TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:BASIL
Authorized Official - Middle Name:J
Authorized Official - Last Name:INGEMI JR
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:856-455-9700
Mailing Address - Street 1:70 MANHEIM AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-2136
Mailing Address - Country:US
Mailing Address - Phone:856-455-9700
Mailing Address - Fax:856-455-9791
Practice Address - Street 1:70 MANHEIM AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-2136
Practice Address - Country:US
Practice Address - Phone:856-455-9700
Practice Address - Fax:856-455-9791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA05636225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ193525Medicare PIN
NJ316704Medicare PIN