Provider Demographics
NPI:1578195004
Name:FORTIFY PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:FORTIFY PHYSICAL THERAPY PC
Other - Org Name:FORTIFY PHYSICAL THERAPY PC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRIERE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:973-525-4347
Mailing Address - Street 1:148 COLLEGE PL
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2506
Mailing Address - Country:US
Mailing Address - Phone:973-525-4347
Mailing Address - Fax:
Practice Address - Street 1:129 W 29TH ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5192
Practice Address - Country:US
Practice Address - Phone:646-822-9461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-12
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY038896OtherLICENSE