Provider Demographics
NPI:1730404799
Name:CHESTER PHYSICAL THERAPY CENTER, PC
Entity type:Organization
Organization Name:CHESTER PHYSICAL THERAPY CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:908-879-8111
Mailing Address - Street 1:P.O. BOX 144
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930-0144
Mailing Address - Country:US
Mailing Address - Phone:908-879-8111
Mailing Address - Fax:908-879-9940
Practice Address - Street 1:154 US ROUTE 206
Practice Address - Street 2:SUITE 1C
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930
Practice Address - Country:US
Practice Address - Phone:908-879-8111
Practice Address - Fax:908-879-9940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-02
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA00556500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ187043Medicare PIN