Provider Demographics
NPI:1598783409
Name:FITNESS IN THERAPY INC.
Entity Type:Organization
Organization Name:FITNESS IN THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:E
Authorized Official - Last Name:POLK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-974-1313
Mailing Address - Street 1:2164 HIGHWAY 35
Mailing Address - Street 2:BLD C
Mailing Address - City:SEA GIRT
Mailing Address - State:NJ
Mailing Address - Zip Code:08750-1013
Mailing Address - Country:US
Mailing Address - Phone:732-974-1313
Mailing Address - Fax:
Practice Address - Street 1:2164 HIGHWAY 35
Practice Address - Street 2:BLD C
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-1013
Practice Address - Country:US
Practice Address - Phone:732-974-1313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA03006225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ041793Medicare PIN