Provider Demographics
NPI:1033477450
Name:HUDSON PREMIERE REHABILITATION & SPORTS THERAPY
Entity Type:Organization
Organization Name:HUDSON PREMIERE REHABILITATION & SPORTS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA GAIL
Authorized Official - Middle Name:F
Authorized Official - Last Name:FRAYNA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:917-733-7763
Mailing Address - Street 1:4800 BROADWAY
Mailing Address - Street 2:SUITE 212
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-6556
Mailing Address - Country:US
Mailing Address - Phone:917-733-7763
Mailing Address - Fax:
Practice Address - Street 1:4800 BROADWAY
Practice Address - Street 2:SUITE 212
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-6556
Practice Address - Country:US
Practice Address - Phone:917-733-7763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01224200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty