Provider Demographics
NPI:1235017344
Name:ENGLEBERT, RUSSELL NEVIN (PTA)
Entity type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:NEVIN
Last Name:ENGLEBERT
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 NJ-168
Mailing Address - Street 2:SUITE A8
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012
Mailing Address - Country:US
Mailing Address - Phone:856-227-1440
Mailing Address - Fax:856-227-1446
Practice Address - Street 1:900 NJ-168
Practice Address - Street 2:SUITE A8
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012
Practice Address - Country:US
Practice Address - Phone:856-227-1440
Practice Address - Fax:856-227-1446
Is Sole Proprietor?:No
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00370800225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant