Provider Demographics
NPI: | 1043604002 |
---|---|
Name: | PREMIER THERAPY SERVICES |
Entity type: | Organization |
Organization Name: | PREMIER THERAPY SERVICES |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PHYSICAL THERAPIST |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | JESSICA |
Authorized Official - Middle Name: | LEIGH |
Authorized Official - Last Name: | SCOLA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DPT |
Authorized Official - Phone: | 856-912-1676 |
Mailing Address - Street 1: | 208 W WAYNE TER |
Mailing Address - Street 2: | APT 18C |
Mailing Address - City: | COLLINGSWOOD |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 08108-2946 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 856-912-1676 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1420 S BLACK HORSE PIKE |
Practice Address - Street 2: | |
Practice Address - City: | WILLIAMSTOWN |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 08094-9130 |
Practice Address - Country: | US |
Practice Address - Phone: | 856-875-0100 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-03-26 |
Last Update Date: | 2015-03-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NJ | 20-4605075 | 314000000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 314000000X | Nursing & Custodial Care Facilities | Skilled Nursing Facility |