1861787483 NPI number — CANA PHYSICAL THERAPY LLC

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 1861787483 NPI number — CANA PHYSICAL THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CANA PHYSICAL THERAPY LLC
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:
1861787483
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 BRIDGE ST
Provider Second Line Business Mailing Address:
C12
Provider Business Mailing Address City Name:
METUCHEN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08840-2273
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-321-1909
Provider Business Mailing Address Fax Number:
732-321-1933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 BRIDGE ST
Provider Second Line Business Practice Location Address:
C12
Provider Business Practice Location Address City Name:
METUCHEN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08840-2273
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-321-1909
Provider Business Practice Location Address Fax Number:
732-321-1933
Provider Enumeration Date:
06/11/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CAJITA
Authorized Official First Name:
SHELLA
Authorized Official Middle Name:
ZARAGOZA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
732-321-1909

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  40QA01250500 , 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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