Provider Demographics
NPI:1720148158
Name:CEDARS THERAPY, LLC
Entity Type:Organization
Organization Name:CEDARS THERAPY, LLC
Other - Org Name:CEDARS THERAPY, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:MIZOBE
Authorized Official - Last Name:CONNOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MS
Authorized Official - Phone:609-922-0814
Mailing Address - Street 1:51 N 3RD ST # 302
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-4517
Mailing Address - Country:US
Mailing Address - Phone:609-922-0814
Mailing Address - Fax:
Practice Address - Street 1:45 N 3RD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-4508
Practice Address - Country:US
Practice Address - Phone:609-922-0814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006318L261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPT006318LOtherPHYSICAL THERAPY LICEN
NJ145254OtherPROVIDER TRANSACTION ACCESS NUMBER GROUP
NJ148676ZCSXOtherMEDICARE GROUP MEMBER NUMBER OR INDIVIDUAL PROVIDER TRANSACTION ACCESS NUMBER