Provider Demographics
NPI:1396379434
Name:RAPHA PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:RAPHA PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:WHILMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANITI
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPY
Authorized Official - Phone:929-333-0882
Mailing Address - Street 1:18 SUMMIT ST APT 230
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1504
Mailing Address - Country:US
Mailing Address - Phone:929-333-0882
Mailing Address - Fax:
Practice Address - Street 1:1119 BROAD ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07114-2501
Practice Address - Country:US
Practice Address - Phone:929-333-0882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty