Provider Demographics
NPI:1164667804
Name:CLASSIC FAMILY REHABILITATION, LLC
Entity Type:Organization
Organization Name:CLASSIC FAMILY REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUMER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:732-698-7108
Mailing Address - Street 1:G11 BRIER HILL CT
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3338
Mailing Address - Country:US
Mailing Address - Phone:732-698-7108
Mailing Address - Fax:
Practice Address - Street 1:G11 BRIER HILL CT
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3338
Practice Address - Country:US
Practice Address - Phone:732-698-7108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01030800261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy