Provider Demographics
NPI:1598151185
Name:TIER 1 DIRECT PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:TIER 1 DIRECT PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:DIPERSIA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS, CAMT
Authorized Official - Phone:201-543-4078
Mailing Address - Street 1:330 CONGERS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07647-1607
Mailing Address - Country:US
Mailing Address - Phone:201-543-4078
Mailing Address - Fax:201-784-1401
Practice Address - Street 1:330 CONGERS AVE
Practice Address - Street 2:
Practice Address - City:NORTHVALE
Practice Address - State:NJ
Practice Address - Zip Code:07647-1607
Practice Address - Country:US
Practice Address - Phone:201-543-4078
Practice Address - Fax:201-784-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01198100261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy