Provider Demographics
NPI:1639225915
Name:ORTHOCARE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ORTHOCARE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOX
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:732-502-8850
Mailing Address - Street 1:3200 SUNSET AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-4567
Mailing Address - Country:US
Mailing Address - Phone:732-502-8850
Mailing Address - Fax:732-502-3199
Practice Address - Street 1:3200 SUNSET AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-4567
Practice Address - Country:US
Practice Address - Phone:732-502-8850
Practice Address - Fax:732-502-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA00760600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ086499Medicare ID - Type UnspecifiedGROUP ID