Provider Demographics
NPI:1093125700
Name:DUPREE PHYSICAL THERAPY AND SPORTS MEDICINE, LLC
Entity Type:Organization
Organization Name:DUPREE PHYSICAL THERAPY AND SPORTS MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUPREE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MS
Authorized Official - Phone:201-693-0974
Mailing Address - Street 1:90 PROSPECT AVE
Mailing Address - Street 2:3B
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1909
Mailing Address - Country:US
Mailing Address - Phone:201-693-0974
Mailing Address - Fax:201-546-1969
Practice Address - Street 1:90 PROSPECT AVE
Practice Address - Street 2:3B
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1909
Practice Address - Country:US
Practice Address - Phone:201-693-0974
Practice Address - Fax:201-546-1969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01113900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty