Provider Demographics
NPI:1417140906
Name:SPECTRUM PHYSICAL THERAPY AND ATHLETIC TRAINING LLC
Entity Type:Organization
Organization Name:SPECTRUM PHYSICAL THERAPY AND ATHLETIC TRAINING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:R
Authorized Official - Last Name:ZACCCONE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, MSPT, SCS
Authorized Official - Phone:201-937-3600
Mailing Address - Street 1:1203 RIVER RD APT 5K
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1442
Mailing Address - Country:US
Mailing Address - Phone:201-937-3600
Mailing Address - Fax:201-731-5192
Practice Address - Street 1:968 RIVER RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-2237
Practice Address - Country:US
Practice Address - Phone:201-937-3600
Practice Address - Fax:201-731-5192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ40QA011077002251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty