Provider Demographics
NPI:1164067757
Name:EXCLUSIVE PHYSICAL THERAPY SERVICES PLLC
Entity Type:Organization
Organization Name:EXCLUSIVE PHYSICAL THERAPY SERVICES PLLC
Other - Org Name:THE BODY LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUTKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:845-800-3811
Mailing Address - Street 1:115 MORRIS ST APT 1434
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-4595
Mailing Address - Country:US
Mailing Address - Phone:845-800-3811
Mailing Address - Fax:
Practice Address - Street 1:239 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-3828
Practice Address - Country:US
Practice Address - Phone:845-800-3811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy