1205305257 NPI number — OUT OF THE BOX PHYSICAL THERAPY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205305257 NPI number — OUT OF THE BOX PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OUT OF THE BOX PHYSICAL THERAPY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205305257
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 THEODORE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANDOLPH
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07869-1913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-479-0756
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16 WING DR STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR KNOLLS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07927-1024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-479-0756
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/20/2018

Additional Information

Authorized Official

Authorized Official Last Name:
SCHENKMAN
Authorized Official First Name:
HANNA
Authorized Official Middle Name:
RAE
Authorized Official Title or Position:
OWNER/CEO
Authorized Official Telephone Number:
973-479-0756

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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