Provider Demographics
NPI:1477617405
Name:BARNEGAT SPORTS REHABILITATION & PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:BARNEGAT SPORTS REHABILITATION & PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:J
Authorized Official - Last Name:GAMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:609-698-1073
Mailing Address - Street 1:890 W BAY AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BARNEGAT
Mailing Address - State:NJ
Mailing Address - Zip Code:08005-2150
Mailing Address - Country:US
Mailing Address - Phone:609-698-1073
Mailing Address - Fax:609-698-1473
Practice Address - Street 1:890 W BAY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BARNEGAT
Practice Address - State:NJ
Practice Address - Zip Code:08005-2150
Practice Address - Country:US
Practice Address - Phone:609-698-1073
Practice Address - Fax:609-698-1473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01038900261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy