Provider Demographics
NPI:1679918783
Name:S R E PHYSICAL THERAPY PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:S R E PHYSICAL THERAPY PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHIARREE
Authorized Official - Middle Name:
Authorized Official - Last Name:EVARISTO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:347-965-3356
Mailing Address - Street 1:2044 CENTER AVE
Mailing Address - Street 2:2FL
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-4930
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2044 CENTER AVE
Practice Address - Street 2:2FL
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-4930
Practice Address - Country:US
Practice Address - Phone:201-585-0636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty