Provider Demographics
NPI:1497909469
Name:LINCOLN PARK PHYSICAL THERAPY AND SPORTS REHABILITATION, LLC
Entity Type:Organization
Organization Name:LINCOLN PARK PHYSICAL THERAPY AND SPORTS REHABILITATION, LLC
Other - Org Name:OPTIMUM HEALTH PHYSICAL THERAPY & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, OCS
Authorized Official - Phone:973-696-2999
Mailing Address - Street 1:212 MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LINCOLN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07035-3700
Mailing Address - Country:US
Mailing Address - Phone:973-696-2999
Mailing Address - Fax:973-696-3030
Practice Address - Street 1:212 MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:LINCOLN PARK
Practice Address - State:NJ
Practice Address - Zip Code:07035-3700
Practice Address - Country:US
Practice Address - Phone:973-696-2999
Practice Address - Fax:973-696-3030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-04
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00750300261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ139285Medicare PIN