Provider Demographics
NPI:1497150361
Name:BURG PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:BURG PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUIZA
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:BURG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:551-221-2231
Mailing Address - Street 1:420 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-7113
Mailing Address - Country:US
Mailing Address - Phone:201-437-0001
Mailing Address - Fax:201-437-0006
Practice Address - Street 1:420 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-7113
Practice Address - Country:US
Practice Address - Phone:201-437-0001
Practice Address - Fax:201-437-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty