Provider Demographics
NPI:1639681109
Name:RESILIENT PERFORMANCE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:RESILIENT PERFORMANCE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAPPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-824-5130
Mailing Address - Street 1:3900 GREYSTONE AVE APT 61C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1928
Mailing Address - Country:US
Mailing Address - Phone:309-824-5130
Mailing Address - Fax:
Practice Address - Street 1:100 PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2848
Practice Address - Country:US
Practice Address - Phone:800-567-1891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy