Provider Demographics
NPI: | 1669817763 |
---|---|
Name: | AM PHYSICAL THERAPY LLC |
Entity Type: | Organization |
Organization Name: | AM PHYSICAL THERAPY LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | MARINA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | DREYTSER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MSPT |
Authorized Official - Phone: | 732-794-3974 |
Mailing Address - Street 1: | 2 LINCOLN HWY |
Mailing Address - Street 2: | STE 510 |
Mailing Address - City: | EDISON |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 08820-3961 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 732-947-4318 |
Mailing Address - Fax: | 732-649-6477 |
Practice Address - Street 1: | 2 LINCOLN HWY |
Practice Address - Street 2: | STE 510 |
Practice Address - City: | EDISON |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 08820-3961 |
Practice Address - Country: | US |
Practice Address - Phone: | 732-947-4318 |
Practice Address - Fax: | 732-649-6477 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-05-02 |
Last Update Date: | 2014-02-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NJ | 40QA00954300 | 174400000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 174400000X | Other Service Providers | Specialist | Group - Single Specialty |