Provider Demographics
NPI:1235757592
Name:REACTIV REHAB & RECOVERY LLC
Entity Type:Organization
Organization Name:REACTIV REHAB & RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BM
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-427-5233
Mailing Address - Street 1:512 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07762-1233
Mailing Address - Country:US
Mailing Address - Phone:347-664-5131
Mailing Address - Fax:732-813-1565
Practice Address - Street 1:512 WARREN AVE
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07762-1233
Practice Address - Country:US
Practice Address - Phone:347-664-5131
Practice Address - Fax:732-813-1565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty