Provider Demographics
NPI:1336211390
Name:PRINCETON REGIONAL PHYSICAL THERAPY
Entity type:Organization
Organization Name:PRINCETON REGIONAL PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOEN
Authorized Official - Middle Name:N
Authorized Official - Last Name:AACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-924-0697
Mailing Address - Street 1:330 NORTH HARRISON STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3524
Mailing Address - Country:US
Mailing Address - Phone:609-924-0697
Mailing Address - Fax:
Practice Address - Street 1:330 N HARRISON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3524
Practice Address - Country:US
Practice Address - Phone:609-924-0697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
024877Medicare ID - Type Unspecified