Provider Demographics
NPI:1699736835
Name:SOMERVILLE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:SOMERVILLE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:908-393-1228
Mailing Address - Street 1:153 N ADAMSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-2742
Mailing Address - Country:US
Mailing Address - Phone:908-393-1228
Mailing Address - Fax:908-393-1230
Practice Address - Street 1:153 N ADAMSVILLE RD
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2742
Practice Address - Country:US
Practice Address - Phone:908-393-1228
Practice Address - Fax:908-393-1230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA00881900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ110000Medicare PIN