Provider Demographics
NPI:1467771865
Name:TRU PHYSICAL THERAPY & WELLNESS, LLC
Entity Type:Organization
Organization Name:TRU PHYSICAL THERAPY & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:CHANTEL
Authorized Official - Last Name:DICKINSON-PANNONE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:551-427-9862
Mailing Address - Street 1:7 WALNUT CT
Mailing Address - Street 2:
Mailing Address - City:NORTH HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-3148
Mailing Address - Country:US
Mailing Address - Phone:973-949-3220
Mailing Address - Fax:
Practice Address - Street 1:7 WALNUT CT
Practice Address - Street 2:
Practice Address - City:NORTH HALEDON
Practice Address - State:NJ
Practice Address - Zip Code:07508-3148
Practice Address - Country:US
Practice Address - Phone:551-427-9862
Practice Address - Fax:973-427-5227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2011-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00863100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty