Provider Demographics
NPI:1306389457
Name:ROCK PHYSICAL THERAPY & SPORTS REHABILITATION INC
Entity Type:Organization
Organization Name:ROCK PHYSICAL THERAPY & SPORTS REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BREMMER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:201-266-8620
Mailing Address - Street 1:251 ROCK RD STE 2E
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-1745
Mailing Address - Country:US
Mailing Address - Phone:201-957-5250
Mailing Address - Fax:
Practice Address - Street 1:251 ROCK RD STE 2E
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452
Practice Address - Country:US
Practice Address - Phone:201-957-5250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-22
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01604200261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy