Provider Demographics
NPI:1215223854
Name:FREEHOLD PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:FREEHOLD PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:SQUICCIARINI
Authorized Official - Suffix:
Authorized Official - Credentials:PTMA
Authorized Official - Phone:732-294-0383
Mailing Address - Street 1:70 TRICENTENNIAL DR
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-5326
Mailing Address - Country:US
Mailing Address - Phone:732-294-0383
Mailing Address - Fax:
Practice Address - Street 1:77 SCHANCK RD
Practice Address - Street 2:SUITE B-11
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2964
Practice Address - Country:US
Practice Address - Phone:732-294-0383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2012-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00460300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty