Provider Demographics
NPI:1114157344
Name:FORWARD MOTION PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:FORWARD MOTION PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:PRATA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, COMT
Authorized Official - Phone:973-454-6065
Mailing Address - Street 1:1111 CLIFTON AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3633
Mailing Address - Country:US
Mailing Address - Phone:973-400-3730
Mailing Address - Fax:973-400-3731
Practice Address - Street 1:1111 CLIFTON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3633
Practice Address - Country:US
Practice Address - Phone:973-400-3730
Practice Address - Fax:973-400-3731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01212000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty