Organization
VITAL PERFORMANCE PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL SHADDOW DPT (OWNER)
(609) 864-1709
Entity
Organization
Contact information
Practice address
9 MARY WAY, HAINESPORT, NJ 08036-2729
(609) 676-5905
Mailing address
130 RANCOCAS RD, MOUNT HOLLY, NJ 08060-1320
(609) 864-1709
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
10/25/2022
Last updated
10/25/2022
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