Provider Demographics
NPI:1710590294
Name:EASY PT LLC
Entity Type:Organization
Organization Name:EASY PT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:P
Authorized Official - Last Name:FAHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-925-7397
Mailing Address - Street 1:4302 KLIMEK PL
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-2942
Mailing Address - Country:US
Mailing Address - Phone:732-925-7397
Mailing Address - Fax:
Practice Address - Street 1:4302 KLIMEK PL
Practice Address - Street 2:
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-2942
Practice Address - Country:US
Practice Address - Phone:732-925-7397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty