Provider Demographics
NPI:1619558590
Name:AMP PERFORMANCE REHAB LLC
Entity Type:Organization
Organization Name:AMP PERFORMANCE REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:ASTORGA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:862-251-2631
Mailing Address - Street 1:787 TABOR RD
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-2731
Mailing Address - Country:US
Mailing Address - Phone:862-251-2631
Mailing Address - Fax:973-370-0699
Practice Address - Street 1:787 TABOR RD
Practice Address - Street 2:
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950-2731
Practice Address - Country:US
Practice Address - Phone:862-251-2631
Practice Address - Fax:973-370-0699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA01565200OtherNJ LICENSE