NPIMap

Organization Active NPI

Victory Physical Therapy PC

  • Physical Therapy Clinic/Center
  • Mullica Hill, NJ
National Provider Identifier
1942309604
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
QA005763 Issued in NJ
Legal business name
VICTORY PHYSICAL THERAPY PC
Practice address
108 Swedesboro Rd
Suite 10
Mullica Hill, NJ 08062-1800
Phone
(856) 223-8898
Fax
(856) 223-8799
NPI assigned
Sep 21, 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
Mr. Michael A Walters, PTNPI 1629034475
Title
Owner
Phone
(856) 223-8898

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 QA005763 NJ Primary

Addresses

Primary practice location

108 Swedesboro Rd
Suite 10
Mullica Hill, NJ 08062-1800

Mailing address

108 Swedesboro Rd
Suite 10
Mullica Hill, NJ 08062-1800
Phone (856) 223-8898

Other identifiers 3

IdentifierTypeStateIssuer
0332711000OtherNJPERSONAL CHOICE
2139173OtherNJAETNA
0332711000OtherNJAMERIHEALTH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040330000027 NJ Part B Supplier - Clinic/Group Practice 1759273097 Receives reassigned benefits from 4 practitioners
Practice locations: Mullica Hill, NJ

National Provider Directory

National Provider Directory

Locations

108 Swedesboro Rd
Ste 10
Mullica Hill, NJ 08062
Phone (609) 223-8898

Practitioners & affiliated clinicians

Practitioners 10

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": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1942309604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 SWEDESBORO RD",
            "address_2": "SUITE 10",
            "city": "MULLICA HILL",
            "state": "NJ",
            "postal_code": "080621800",
            "telephone_number": "856-223-8898",
            "fax_number": "856-223-8799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 SWEDESBORO RD",
            "address_2": "SUITE 10",
            "city": "MULLICA HILL",
            "state": "NJ",
            "postal_code": "080621800",
            "telephone_number": "856-223-8898",
            "fax_number": "856-223-8799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY PHYSICAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WALTERS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "856-223-8898",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NJ",
            "license": "QA005763",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL CHOICE",
            "identifier": "0332711000",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2139173",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH",
            "identifier": "0332711000",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mullica Hill, 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.
  • 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.