Provider Demographics
NPI:1811773385
Name:WELLNESS CENTERS OF SOUTH JERSEY LLC
Entity type:Organization
Organization Name:WELLNESS CENTERS OF SOUTH JERSEY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:URBAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-229-1794
Mailing Address - Street 1:49 BETHEL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-1601
Mailing Address - Country:US
Mailing Address - Phone:609-904-9404
Mailing Address - Fax:
Practice Address - Street 1:49 BETHEL RD STE 100
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-1601
Practice Address - Country:US
Practice Address - Phone:609-904-9404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty