Provider Demographics
NPI:1205950581
Name:SAM'S KIDS PEDIATRIC THERAPY
Entity type:Organization
Organization Name:SAM'S KIDS PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:MARKLE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:908-454-8687
Mailing Address - Street 1:604 LYNDA RD
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1743
Mailing Address - Country:US
Mailing Address - Phone:908-454-8687
Mailing Address - Fax:908-454-6279
Practice Address - Street 1:604 LYNDA RD
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1743
Practice Address - Country:US
Practice Address - Phone:908-454-8687
Practice Address - Fax:908-454-6279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2015-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA002170002251P0200X, 2251P0200X
NJ40QA006915002251P0200X
NJ46TR00138700225XP0200X
NJ40QA005364002251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty