Provider Demographics
NPI:1942692561
Name:PHYSICAL THERAPY CENTER OF EXCELLENCE, LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY CENTER OF EXCELLENCE, LLC
Other - Org Name:PTCOE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:HAHN
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:480-703-2111
Mailing Address - Street 1:PO BOX 21
Mailing Address - Street 2:
Mailing Address - City:PLUCKEMIN
Mailing Address - State:NJ
Mailing Address - Zip Code:07978-0021
Mailing Address - Country:US
Mailing Address - Phone:908-722-9000
Mailing Address - Fax:
Practice Address - Street 1:1420 US HIGHWAY 206 STE 100
Practice Address - Street 2:
Practice Address - City:BEDMINSTER
Practice Address - State:NJ
Practice Address - Zip Code:07921-2642
Practice Address - Country:US
Practice Address - Phone:908-722-9000
Practice Address - Fax:908-722-9001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-19
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01213300261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy