1861430357 NPI number — THERAWORKS PHYSICAL THERAPY AND REHABILITATION LLC

Table of content: (NPI 1861430357)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861430357 NPI number — THERAWORKS PHYSICAL THERAPY AND REHABILITATION LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERAWORKS PHYSICAL THERAPY AND REHABILITATION LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
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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:
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NPI Number Information

NPI Number:
1861430357
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 324
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARNEGAT
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08005-0324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-290-2299
Provider Business Mailing Address Fax Number:
732-749-8429

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 FREEDOM HILLS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARNEGAT
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08005-1829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-290-2299
Provider Business Practice Location Address Fax Number:
732-749-8429
Provider Enumeration Date:
06/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SARES
Authorized Official First Name:
ELEAZAR
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
732-290-2299

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  40QA01134700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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