Provider Demographics
NPI:1780567438
Name:MAPLE LEAF PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:MAPLE LEAF PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:T
Authorized Official - Last Name:EGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:609-417-1312
Mailing Address - Street 1:257 MESSINA AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1327
Mailing Address - Country:US
Mailing Address - Phone:609-561-1974
Mailing Address - Fax:
Practice Address - Street 1:255 MESSINA AVE
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1327
Practice Address - Country:US
Practice Address - Phone:609-561-1974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-29
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy