Provider Demographics
NPI:1871212183
Name:SOULRISE PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:SOULRISE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PANDEY-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-433-4008
Mailing Address - Street 1:1907 DEPTFORD CENTER RD STE 3
Mailing Address - Street 2:
Mailing Address - City:DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-5633
Mailing Address - Country:US
Mailing Address - Phone:856-433-4008
Mailing Address - Fax:
Practice Address - Street 1:912 KINGS HWY
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1218
Practice Address - Country:US
Practice Address - Phone:856-433-4008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-22
Last Update Date:2022-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty