Provider Demographics
NPI:1043763931
Name:C.A.R.Y.N. PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:C.A.R.Y.N. PHYSICAL THERAPY LLC
Other - Org Name:SEVILLE PHYSICAL THERAPY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:PURISSA
Authorized Official - Middle Name:ALCUINO
Authorized Official - Last Name:SEVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:210-537-4888
Mailing Address - Street 1:233 GARDEN PL
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-2217
Mailing Address - Country:US
Mailing Address - Phone:201-537-4888
Mailing Address - Fax:201-734-6132
Practice Address - Street 1:82 N. SUMMIT ST.
Practice Address - Street 2:1ST FLOOR, SUITE D
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-2027
Practice Address - Country:US
Practice Address - Phone:201-537-4888
Practice Address - Fax:201-734-6132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA008403 00261QP2000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy