Provider Demographics
NPI:1386986719
Name:CROSS TRAINING REHABILITATION, LLC
Entity type:Organization
Organization Name:CROSS TRAINING REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:215-806-4421
Mailing Address - Street 1:107 CHERRY DR
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5344
Mailing Address - Country:US
Mailing Address - Phone:215-806-4421
Mailing Address - Fax:
Practice Address - Street 1:107 CHERRY DR
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TWP
Practice Address - State:NJ
Practice Address - Zip Code:08234-5344
Practice Address - Country:US
Practice Address - Phone:215-806-4421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-24
Last Update Date:2013-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01007400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty