Provider Demographics
NPI:1861632358
Name:MATHER, ELLEN J (PHYSICAL THERAPIST A)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:J
Last Name:MATHER
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 LAUREL HEIGHTS DR.
Mailing Address - Street 2:BLDG #4
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-3634
Mailing Address - Country:US
Mailing Address - Phone:856-455-9730
Mailing Address - Fax:856-455-5165
Practice Address - Street 1:2848 S. DELSEA DR.
Practice Address - Street 2:BLDG #3
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-7042
Practice Address - Country:US
Practice Address - Phone:856-696-0404
Practice Address - Fax:856-696-8555
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00076900225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant