Provider Demographics
NPI:1578181541
Name:TRIDENT AT HOME PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:TRIDENT AT HOME PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BHAVESH
Authorized Official - Middle Name:D
Authorized Official - Last Name:MISTRY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:908-565-1037
Mailing Address - Street 1:PO BOX 22
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-0022
Mailing Address - Country:US
Mailing Address - Phone:908-565-1037
Mailing Address - Fax:
Practice Address - Street 1:5 E FRANCIS AVE
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-1227
Practice Address - Country:US
Practice Address - Phone:908-565-1037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy