Provider Demographics
NPI:1588618177
Name:CREST SPORTS TRNG PHYL THPY
Entity Type:Organization
Organization Name:CREST SPORTS TRNG PHYL THPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CALABRO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-212-0060
Mailing Address - Street 1:66 W GILBERT ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4918
Mailing Address - Country:US
Mailing Address - Phone:732-212-0060
Mailing Address - Fax:732-212-0061
Practice Address - Street 1:1904 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1006
Practice Address - Country:US
Practice Address - Phone:732-212-0060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJDE8996OtherRAILROAD MEDICARE
NJ101459Medicare PIN