NPIMap

Organization Active NPI

Barnegat Sports Rehabilitation & Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Barnegat, NJ
National Provider Identifier
1477617405
Registry record updated Jan 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
40QA01038900 Issued in NJ
Legal business name
BARNEGAT SPORTS REHABILITATION & PHYSICAL THERAPY LLC
Practice address
890 W Bay Ave
Suite a
Barnegat, NJ 08005-2150
Phone
(609) 698-1073
Fax
(609) 698-1473
NPI assigned
Dec 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2008

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

Authorized official

Name
Mr. Ernest J Gamble, PTNPI 1467560748
Title
Owner
Phone
(609) 698-1073

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 Therapy Clinic/Center 261QP2000X 40QA01038900 NJ Primary

Addresses

Primary practice location

890 W Bay Ave
Suite a
Barnegat, NJ 08005-2150

Mailing address

890 W Bay Ave
Suite a
Barnegat, NJ 08005-2150
Phone (609) 698-1073

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080214000021 NJ Part B Supplier - Physical/Occupational Therapy Group in Private Practice 8628151693 Receives reassigned benefits from 20 practitioners
Practice locations: Waretown, NJ; Little Egg Harbor TWP, NJ; Barnegat, NJ; Manahawkin, NJ

National Provider Directory

National Provider Directory

Locations

770 Lighthouse Dr
Ste 170B
Barnegat, NJ 08005
Phone (609) 698-1073

770 Lighthouse Dr
Unit 170
Barnegat, NJ 08005
Phone (609) 698-1073

890 W Bay Ave
Ste A
Barnegat, NJ 08005
Phone (609) 698-1073

200 Mathistown Rd
Unit 5
Little Egg Harbor Twp, NJ 08087
Phone (609) 857-5697

602 Route 72 E
Ste 3
Manahawkin, NJ 08050
Phone (609) 549-5015

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200355200000",
    "number": "1477617405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "890 W BAY AVE",
            "address_2": "SUITE A",
            "city": "BARNEGAT",
            "state": "NJ",
            "postal_code": "080052150",
            "telephone_number": "609-698-1073",
            "fax_number": "609-698-1473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "890 W BAY AVE",
            "address_2": "SUITE A",
            "city": "BARNEGAT",
            "state": "NJ",
            "postal_code": "080052150",
            "telephone_number": "609-698-1073",
            "fax_number": "609-698-1473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BARNEGAT SPORTS REHABILITATION & PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-21",
        "last_updated": "2008-01-15",
        "status": "A",
        "authorized_official_last_name": "GAMBLE",
        "authorized_official_first_name": "ERNEST",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "609-698-1073",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NJ",
            "license": "40QA01038900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Barnegat, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.