Provider Demographics
NPI:1033105325
Name:MATRIX PHYSICAL THERAPY,LLC
Entity Type:Organization
Organization Name:MATRIX PHYSICAL THERAPY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LIEBOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:212-794-0820
Mailing Address - Street 1:222 KINDERKAMACK RD
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-2259
Mailing Address - Country:US
Mailing Address - Phone:212-794-0820
Mailing Address - Fax:201-265-9817
Practice Address - Street 1:222 KINDERKAMACK RD
Practice Address - Street 2:
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-2259
Practice Address - Country:US
Practice Address - Phone:212-794-0820
Practice Address - Fax:201-265-9817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01179000261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy