Provider Demographics
NPI:1639684723
Name:RAPPA, TREVOR (PT, DPT, CSCS)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:
Last Name:RAPPA
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 COLLEGE PL
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2506
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:309-824-5130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01731900225100000X
NY038952225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist