Provider Demographics
NPI:1093385676
Name:PHYSIOPROS PERFORMANCE AND REHABILITATION LLC
Entity Type:Organization
Organization Name:PHYSIOPROS PERFORMANCE AND REHABILITATION LLC
Other - Org Name:PHYSIOPROS PERFORMANCE REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:973-713-3805
Mailing Address - Street 1:3799 ROUTE 46 STE 110
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-1060
Mailing Address - Country:US
Mailing Address - Phone:973-265-8621
Mailing Address - Fax:
Practice Address - Street 1:3799 ROUTE 46 STE 110
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-1060
Practice Address - Country:US
Practice Address - Phone:973-713-3805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty