Provider Demographics
NPI:1124413505
Name:PREMIER THERAPY SERVICES
Entity Type:Organization
Organization Name:PREMIER THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ISAO
Authorized Official - Middle Name:
Authorized Official - Last Name:KITAGUCHI
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:201-681-2581
Mailing Address - Street 1:5 BOROLINE RD
Mailing Address - Street 2:
Mailing Address - City:SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-2343
Mailing Address - Country:US
Mailing Address - Phone:201-818-8680
Mailing Address - Fax:
Practice Address - Street 1:5 BOROLINE RD
Practice Address - Street 2:
Practice Address - City:SADDLE RIVER
Practice Address - State:NJ
Practice Address - Zip Code:07458-2343
Practice Address - Country:US
Practice Address - Phone:201-818-8680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REVERA INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00669800320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities