Provider Demographics
NPI:1427207752
Name:TRINITY PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:TRINITY PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ABIMBOLA
Authorized Official - Middle Name:O
Authorized Official - Last Name:FADAHUNSI
Authorized Official - Suffix:
Authorized Official - Credentials:P T
Authorized Official - Phone:908-295-9093
Mailing Address - Street 1:20 FULTON RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-2326
Mailing Address - Country:US
Mailing Address - Phone:732-246-2536
Mailing Address - Fax:732-246-0428
Practice Address - Street 1:20 FULTON RD
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-2326
Practice Address - Country:US
Practice Address - Phone:732-246-2536
Practice Address - Fax:732-246-0428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00599300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty