Provider Demographics
NPI:1285028217
Name:ORTHOSPORTS PHYSICAL THERAPY AND REHABILITATION PC
Entity Type:Organization
Organization Name:ORTHOSPORTS PHYSICAL THERAPY AND REHABILITATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:973-393-5545
Mailing Address - Street 1:710 MILL ST
Mailing Address - Street 2:H3
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-5318
Mailing Address - Country:US
Mailing Address - Phone:973-759-1494
Mailing Address - Fax:973-759-0557
Practice Address - Street 1:1060 BROAD ST
Practice Address - Street 2:GRND FLOOR
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2397
Practice Address - Country:US
Practice Address - Phone:973-558-5353
Practice Address - Fax:973-558-5355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00978900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty