Provider Demographics
NPI:1265038160
Name:PROACTIVITY FITNESS PHYSICAL THERAPY ASSOCIATES
Entity Type:Organization
Organization Name:PROACTIVITY FITNESS PHYSICAL THERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL OPERATIONS
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BAGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:908-730-6640
Mailing Address - Street 1:1250 STATE ROUTE 31
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NJ
Mailing Address - Zip Code:08833-3238
Mailing Address - Country:US
Mailing Address - Phone:908-730-6640
Mailing Address - Fax:908-730-0468
Practice Address - Street 1:1250 STATE ROUTE 31
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NJ
Practice Address - Zip Code:08833-3238
Practice Address - Country:US
Practice Address - Phone:908-730-6640
Practice Address - Fax:908-730-0468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty