NPIMap

Organization Active NPI

Gloucester Physical Therapy, PC

  • Physical Therapist
  • Paulsboro, NJ
National Provider Identifier
1295837722
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
40QA00685900 Issued in NJ
Legal business name
GLOUCESTER PHYSICAL THERAPY, PC
Practice address
541 Mantua Ave
Paulsboro, NJ 08066-1178
Phone
(856) 224-0400
Fax
(856) 224-0466
NPI assigned
Sep 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Maikutlo B Kebaetse, PHD, PTNPI 1326190653
Title
President
Phone
(856) 224-0400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 40QA00685900 NJ Primary

Addresses

Primary practice location

541 Mantua Ave
Paulsboro, NJ 08066-1178

Mailing address

PO Box 277
Paulsboro, NJ 08066-0277
Phone (856) 224-0400

Other identifiers 2

IdentifierTypeStateIssuer
2410631000OtherNJAMERIHEALTH IND. ID #
2410669000OtherNJAMERIHEALTH GROUP ID

National Provider Directory

National Provider Directory

Locations

541 Mantua Ave
Paulsboro, NJ 08066
Phone (856) 224-0400

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1295837722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 277",
            "city": "PAULSBORO",
            "state": "NJ",
            "postal_code": "080660277",
            "telephone_number": "856-224-0400",
            "fax_number": "856-224-0466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "541 MANTUA AVE",
            "city": "PAULSBORO",
            "state": "NJ",
            "postal_code": "080661178",
            "telephone_number": "856-224-0400",
            "fax_number": "856-224-0466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLOUCESTER PHYSICAL THERAPY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KEBAETSE",
        "authorized_official_first_name": "MAIKUTLO",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "856-224-0400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD, PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA00685900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH IND. ID #",
            "identifier": "2410631000",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH GROUP ID",
            "identifier": "2410669000",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Paulsboro, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.