Provider Demographics
NPI:1821160250
Name:SPORTS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SPORTS PHYSICAL THERAPY
Other - Org Name:SPORTS PHYSICAL THERAPY HILLSBOROUGH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BORER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-369-8850
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:THREE BRIDGES
Mailing Address - State:NJ
Mailing Address - Zip Code:08887-0310
Mailing Address - Country:US
Mailing Address - Phone:908-806-2645
Mailing Address - Fax:908-806-5228
Practice Address - Street 1:220 TRIANGLE ROAD
Practice Address - Street 2:SUITE 240
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844
Practice Address - Country:US
Practice Address - Phone:908-369-8850
Practice Address - Fax:908-369-8895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
092289Medicare ID - Type Unspecified