Provider Demographics
NPI:1114342938
Name:PEAK MOTION PHYSICAL THERAPY, PA
Entity Type:Organization
Organization Name:PEAK MOTION PHYSICAL THERAPY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLO
Authorized Official - Middle Name:
Authorized Official - Last Name:UCOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-837-6600
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-0128
Mailing Address - Country:US
Mailing Address - Phone:973-837-6600
Mailing Address - Fax:
Practice Address - Street 1:360 W CLINTON ST
Practice Address - Street 2:
Practice Address - City:HALEDON
Practice Address - State:NJ
Practice Address - Zip Code:07508-1528
Practice Address - Country:US
Practice Address - Phone:973-837-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-03
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ344860Medicare PIN