Provider Demographics
NPI:1518109305
Name:ADVANCE SPINE AND PAIN PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:ADVANCE SPINE AND PAIN PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:609-695-8100
Mailing Address - Street 1:225 E STATE ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08608-1800
Mailing Address - Country:US
Mailing Address - Phone:609-695-8100
Mailing Address - Fax:609-695-8110
Practice Address - Street 1:225 E STATE ST
Practice Address - Street 2:SUITE 11
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08608-1800
Practice Address - Country:US
Practice Address - Phone:609-695-8100
Practice Address - Fax:609-695-8110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-25
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA001087200261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy