1689047326 NPI number — BEYOND BASICS PHYSICAL THERAPY

Table of content: ASHLEY LEANN CALDWELL LPCC (NPI 1700625506)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689047326 NPI number — BEYOND BASICS PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEYOND BASICS 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:
1689047326
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
88 MAZUR PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAWTHORNE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07506-3519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-873-8534
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 E 42ND ST
Provider Second Line Business Practice Location Address:
SUITE 1504
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10017-5611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-354-2622
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/03/2015

Additional Information

Authorized Official

Authorized Official Last Name:
LAMANNA
Authorized Official First Name:
VICTORIA
Authorized Official Middle Name:
JOANNE
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
212-354-2622

Provider Taxonomy Codes

  • Taxonomy code: 302F00000X , with the licence number:  039241 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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