Provider Demographics
NPI:1568876233
Name:INTEGRATED PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:INTEGRATED PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:GIANNELLI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-904-2051
Mailing Address - Street 1:860 WYCKOFF AVE
Mailing Address - Street 2:UNIT 1 NW
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-3186
Mailing Address - Country:US
Mailing Address - Phone:201-904-2051
Mailing Address - Fax:
Practice Address - Street 1:860 WYCKOFF AVE
Practice Address - Street 2:UNIT 1 NW
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-3186
Practice Address - Country:US
Practice Address - Phone:201-904-2051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-20
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00288000261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy