Active NPI
Fast Track Physical Therapy, LLC
- Physical Therapy Clinic/Center
- Somerdale, NJ
National Provider Identifier
1992009203
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Clinic/Center
- License
- 40QA01113200
- Legal business name
- FAST TRACK PHYSICAL THERAPY, LLC
- Practice address
- 700 S White Horse Pike
Suite D
Somerdale, NJ 08083-1253 - Phone
- (856) 504-6930
- Fax
- (856) 504-6934
- NPI assigned
- Dec 29, 2010
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Kevin L Laser, P.T.
- Title
- Owner/Physical Therapist
- Phone
- (856) 504-6930
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Clinic/Center | 261QP2000X | 40QA01113200 | NJ | Primary |
Addresses
Primary practice location
700 S White Horse Pike
Suite D
Somerdale, NJ 08083-1253
Mailing address
PO Box 9
Somerdale, NJ 08083-0009
Phone (856) 504-6930
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110318000491 | NJ | Part B Supplier - Clinic/Group Practice | 1557544137 |
Receives reassigned benefits from 7 practitioners Practice locations: Somerdale, NJ |
National Provider Directory
National Provider DirectoryLocations
700 S White Horse Pike
Ste D
Somerdale, NJ 08083
Phone (856) 504-6930
Practitioners & affiliated clinicians
Practitioners 8
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Physical Therapist
- Cherry Hill, NJ
- NPI 1639774193
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1293580800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1343433600000",
"number": "1992009203",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9",
"city": "SOMERDALE",
"state": "NJ",
"postal_code": "080830009",
"telephone_number": "856-504-6930",
"fax_number": "856-504-6934"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 S WHITE HORSE PIKE",
"address_2": "SUITE D",
"city": "SOMERDALE",
"state": "NJ",
"postal_code": "080831253",
"telephone_number": "856-504-6930",
"fax_number": "856-504-6934"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FAST TRACK PHYSICAL THERAPY, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2010-12-29",
"last_updated": "2012-07-28",
"status": "A",
"authorized_official_last_name": "LASER",
"authorized_official_first_name": "KEVIN",
"authorized_official_middle_name": "L",
"authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
"authorized_official_telephone_number": "856-504-6930",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "P.T."
},
"taxonomies": [
{
"code": "261QP2000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Physical Therapy",
"state": "NJ",
"license": "40QA01113200",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Somerdale, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2012; 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.