Provider Demographics
NPI:1578830576
Name:CARUSO PHYSICAL THERAPY AND NUTRITION, LLC
Entity Type:Organization
Organization Name:CARUSO PHYSICAL THERAPY AND NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CARUSO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, RDN
Authorized Official - Phone:609-738-3143
Mailing Address - Street 1:1278 YARDVILLE ALLENTOWN RD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08501-1866
Mailing Address - Country:US
Mailing Address - Phone:609-584-9594
Mailing Address - Fax:609-584-9594
Practice Address - Street 1:1278 YARDVILLE ALLENTOWN RD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08501-1866
Practice Address - Country:US
Practice Address - Phone:609-584-9594
Practice Address - Fax:609-584-9594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-19
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QP2000X261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ096178UDEOtherMEDICARE ID- TYPE UNSPECIFIED