Provider Demographics
NPI:1528128600
Name:CROSS KEYS PHYSICAL THERAPY SPORTS MEDICAL CENTER, INC
Entity type:Organization
Organization Name:CROSS KEYS PHYSICAL THERAPY SPORTS MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANSELMO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:856-374-3707
Mailing Address - Street 1:151 FRIES MILL RD
Mailing Address - Street 2:BLDG. 600,STE. 1
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-2016
Mailing Address - Country:US
Mailing Address - Phone:856-374-3707
Mailing Address - Fax:856-374-3709
Practice Address - Street 1:151 FRIES MILL RD
Practice Address - Street 2:BLDG. 600,STE. 1
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-2016
Practice Address - Country:US
Practice Address - Phone:856-374-3707
Practice Address - Fax:856-374-3709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00318009OtherRAILROAD MCR
NJ0122318OtherAETNA PROV. #
NJ904495OtherUNITED HEALTH CARE
NJ0825493000OtherAMERIHEALTH
NJ904495OtherUNITED HEALTH CARE