Provider Demographics
NPI:1245569086
Name:ADVANCED CARE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:ADVANCED CARE PHYSICAL THERAPY, LLC
Other - Org Name:ALL CARE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:848-248-9755
Mailing Address - Street 1:670 N BEERS ST
Mailing Address - Street 2:BUILDING 1-SUITE 110
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1516
Mailing Address - Country:US
Mailing Address - Phone:732-203-0104
Mailing Address - Fax:
Practice Address - Street 1:670 N BEERS ST
Practice Address - Street 2:BUILDING 1-SUITE 110
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1516
Practice Address - Country:US
Practice Address - Phone:732-203-0104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01135800261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy