Provider Demographics
NPI:1760653232
Name:THEATRE ARTS PHYSIOTHERAPY, LLC
Entity Type:Organization
Organization Name:THEATRE ARTS PHYSIOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIGRID
Authorized Official - Middle Name:
Authorized Official - Last Name:SCRUGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-422-0888
Mailing Address - Street 1:5 REGENT ST
Mailing Address - Street 2:SUITE 503
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-1675
Mailing Address - Country:US
Mailing Address - Phone:973-422-0888
Mailing Address - Fax:
Practice Address - Street 1:5 REGENT ST
Practice Address - Street 2:SUITE 503
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-1675
Practice Address - Country:US
Practice Address - Phone:973-422-0888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2012-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0600130702225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
080022Medicare UPIN