Provider Demographics
NPI:1033639976
Name:MONMOUTH SCHROTH SCOLIOSIS PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:MONMOUTH SCHROTH SCOLIOSIS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:917-402-7237
Mailing Address - Street 1:41 LONDON ST
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2723
Mailing Address - Country:US
Mailing Address - Phone:917-402-7237
Mailing Address - Fax:732-414-2489
Practice Address - Street 1:77 SCHANCK RD STE C3
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2964
Practice Address - Country:US
Practice Address - Phone:917-402-7237
Practice Address - Fax:732-414-2489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01639500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty