Provider Demographics
NPI:1801879457
Name:CENTER FOR ORTHOPEDIC & SPINE PHYSICALTHERAPY, PC
Entity type:Organization
Organization Name:CENTER FOR ORTHOPEDIC & SPINE PHYSICALTHERAPY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:SEGUI
Authorized Official - Last Name:RAMISCAL
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT, OCS,FAAOMPT
Authorized Official - Phone:609-721-1492
Mailing Address - Street 1:22 WOODSTONE LN
Mailing Address - Street 2:UNIT A
Mailing Address - City:BURLINGTON TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-4333
Mailing Address - Country:US
Mailing Address - Phone:609-721-1492
Mailing Address - Fax:609-227-4423
Practice Address - Street 1:11 CADILLAC RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-4815
Practice Address - Country:US
Practice Address - Phone:609-880-0880
Practice Address - Fax:609-227-4423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2251X0800X, 2251S0007X, 225XH1200X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ097580Medicare PIN