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Organization
GLOUCESTER PHYSICAL THERAPY, PC
Active
Organization
GLOUCESTER PHYSICAL THERAPY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MAIKUTLO B KEBAETSE PHD, PT (PRESIDENT)
(856) 224-0400
Entity
Organization
Contact information
Practice address
541 MANTUA AVE, PAULSBORO, NJ 08066-1178
(856) 224-0400
(856) 224-0466
Mailing address
PO BOX 277, PAULSBORO, NJ 08066-0277
(856) 224-0400
(856) 224-0466
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
40QA00685900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2410631000
AMERIHEALTH IND. ID #
NJ
01
—
2410669000
AMERIHEALTH GROUP ID
NJ
Enumeration date
09/04/2006
Last updated
08/22/2020
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