Provider Demographics
NPI:1275050619
Name:TALARIA PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:TALARIA PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEMETRI
Authorized Official - Middle Name:E
Authorized Official - Last Name:DIMITRIADIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:201-588-6290
Mailing Address - Street 1:1021 KINGSLAND LN
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-1528
Mailing Address - Country:US
Mailing Address - Phone:646-245-6517
Mailing Address - Fax:201-588-6059
Practice Address - Street 1:75 OAK ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07648-1394
Practice Address - Country:US
Practice Address - Phone:201-588-6290
Practice Address - Fax:201-588-6059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-26
Last Update Date:2017-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01409300225100000X, 2251S0007X, 2251X0800X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty