Provider Demographics
NPI:1407050784
Name:EASTERN MONMOUTH PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:EASTERN MONMOUTH PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MS,PT
Authorized Official - Phone:732-922-6618
Mailing Address - Street 1:301 BINGHAM AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-4764
Mailing Address - Country:US
Mailing Address - Phone:732-922-6618
Mailing Address - Fax:732-922-6619
Practice Address - Street 1:301 BINGHAM AVE
Practice Address - Street 2:SUITE A
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-4764
Practice Address - Country:US
Practice Address - Phone:732-922-6618
Practice Address - Fax:732-922-6619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA0859400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ066208RCFMedicare ID - Type UnspecifiedMEDICARE
NJ066207RCFMedicare ID - Type UnspecifiedMEDICARE