Provider Demographics
NPI:1760079099
Name:PHYSICAL THERAPY GYM, LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY GYM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:DELUNA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:469-432-1975
Mailing Address - Street 1:157 TAPPAN ST
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-3316
Mailing Address - Country:US
Mailing Address - Phone:732-979-7456
Mailing Address - Fax:
Practice Address - Street 1:365 BROAD ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2737
Practice Address - Country:US
Practice Address - Phone:609-795-2534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty