Provider Demographics
NPI:1104900638
Name:HADDON PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:HADDON PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DALSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-795-9222
Mailing Address - Street 1:807 N HADDON AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-1749
Mailing Address - Country:US
Mailing Address - Phone:856-795-9222
Mailing Address - Fax:856-795-0126
Practice Address - Street 1:807 N HADDON AVE
Practice Address - Street 2:STE 2
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-1749
Practice Address - Country:US
Practice Address - Phone:856-795-9222
Practice Address - Fax:856-795-0126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00920600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty