Provider Demographics
NPI:1346457199
Name:ALL CARE PHYSICAL THERAPY & SPORTS TRAINING LLC
Entity Type:Organization
Organization Name:ALL CARE PHYSICAL THERAPY & SPORTS TRAINING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:FAHS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:908-688-8628
Mailing Address - Street 1:2500 MORRIS AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5600
Mailing Address - Country:US
Mailing Address - Phone:908-688-8628
Mailing Address - Fax:
Practice Address - Street 1:2500 MORRIS AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5600
Practice Address - Country:US
Practice Address - Phone:908-688-8628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQAO8393261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ029020Medicare ID - Type Unspecified