Provider Demographics
NPI:1437126091
Name:ADVANCED PHYSICAL THERAPY AND WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY AND WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:DICKERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-305-0700
Mailing Address - Street 1:61 BEAVERBROOK RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LINCOLN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07035-1748
Mailing Address - Country:US
Mailing Address - Phone:973-305-0700
Mailing Address - Fax:973-305-0704
Practice Address - Street 1:61 BEAVERBROOK RD
Practice Address - Street 2:SUITE 103
Practice Address - City:LINCOLN PARK
Practice Address - State:NJ
Practice Address - Zip Code:07035-1748
Practice Address - Country:US
Practice Address - Phone:973-305-0700
Practice Address - Fax:973-305-0704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ096766Medicare PIN