Provider Demographics
NPI:1043566367
Name:MAXIMUM PERFORMANCE PHYSICAL THERAPY AND SPORTS REHABILITATION
Entity Type:Organization
Organization Name:MAXIMUM PERFORMANCE PHYSICAL THERAPY AND SPORTS REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:VANDIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:201-991-3800
Mailing Address - Street 1:170 SCHUYLER AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH ARLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07031-5412
Mailing Address - Country:US
Mailing Address - Phone:201-991-3800
Mailing Address - Fax:201-991-4800
Practice Address - Street 1:170 SCHUYLER AVE STE 3
Practice Address - Street 2:
Practice Address - City:NORTH ARLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07031-5425
Practice Address - Country:US
Practice Address - Phone:201-991-3800
Practice Address - Fax:201-991-4800
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAXIMUM PERFORMANCE PHYSICAL THERAPY AND SPORTS REHABILITATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-24
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01259400261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy