Provider Demographics
NPI:1104871128
Name:ASPEN PHYSICAL THERAPY, P.A.
Entity type:Organization
Organization Name:ASPEN PHYSICAL THERAPY, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICKETT
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MPT, NCS, GCS
Authorized Official - Phone:609-261-3434
Mailing Address - Street 1:300 CAMPUS DR
Mailing Address - Street 2:RR #30
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-9604
Mailing Address - Country:US
Mailing Address - Phone:609-261-3434
Mailing Address - Fax:
Practice Address - Street 1:300 CAMPUS DR
Practice Address - Street 2:RR #30
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-9604
Practice Address - Country:US
Practice Address - Phone:609-261-3434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4188460001Medicare NSC
NJ316589Medicare ID - Type UnspecifiedPROVIDER