Provider Demographics
NPI:1609430339
Name:GARDEN STATE PHYSICAL THERAPY AND CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:GARDEN STATE PHYSICAL THERAPY AND CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NOAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-414-6060
Mailing Address - Street 1:1503 SAINT GEORGES AVE
Mailing Address - Street 2:
Mailing Address - City:COLONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07067-3425
Mailing Address - Country:US
Mailing Address - Phone:732-414-6060
Mailing Address - Fax:
Practice Address - Street 1:1503 SAINT GEORGES AVE
Practice Address - Street 2:
Practice Address - City:COLONIA
Practice Address - State:NJ
Practice Address - Zip Code:07067-3425
Practice Address - Country:US
Practice Address - Phone:732-414-6060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GARDEN STATE PHYSICAL THERAPY AND CHIROPRACTIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty