1871962175 NPI number — PURSUE PHYSICAL THERAPY & PERFORMANCE TRAINING

Table of content: JESSICA MICHELLE CATELLIER MED (NPI 1649930355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871962175 NPI number — PURSUE PHYSICAL THERAPY & PERFORMANCE TRAINING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PURSUE PHYSICAL THERAPY & PERFORMANCE TRAINING
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:
1871962175
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
271 GROVE AVE STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VERONA
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07044-1729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-340-4846
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
271 GROVE AVE STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VERONA
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07044-1729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-340-4846
Provider Business Practice Location Address Fax Number:
973-513-6105
Provider Enumeration Date:
09/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
CRUZ
Authorized Official First Name:
BRANDON
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICAL THERAPIST/OWNER
Authorized Official Telephone Number:
973-271-3368

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  25MZ00129400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251S0007X , with the licence number: 40QA01514700 , 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)

  • Identifier: 1134580988 . This is a "NPI- JASON PARK" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1407273642 . This is a "NPI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1447684642 . This is a "NPI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1033612163 . This is a "ACUPUNCTURE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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