Provider Demographics
NPI:1326374570
Name:FIVE POINTS PHYSICAL THERAPY AND REHAB CTR LLC
Entity Type:Organization
Organization Name:FIVE POINTS PHYSICAL THERAPY AND REHAB CTR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICKLAUS
Authorized Official - Middle Name:
Authorized Official - Last Name:DIZON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-451-9900
Mailing Address - Street 1:623 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-9318
Mailing Address - Country:US
Mailing Address - Phone:201-451-9900
Mailing Address - Fax:
Practice Address - Street 1:623 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-9318
Practice Address - Country:US
Practice Address - Phone:201-451-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0400311785261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy