Provider Demographics
NPI:1790287472
Name:PARAGON SPORTS REHAB, LLC
Entity Type:Organization
Organization Name:PARAGON SPORTS REHAB, LLC
Other - Org Name:JIM THOLANY PT, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:THOLANY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:914-443-8150
Mailing Address - Street 1:1 N COMMERCE SQ STE 102
Mailing Address - Street 2:
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08691-0003
Mailing Address - Country:US
Mailing Address - Phone:914-443-8150
Mailing Address - Fax:
Practice Address - Street 1:127 ROUTE 206
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08610-4300
Practice Address - Country:US
Practice Address - Phone:609-807-1760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA013592002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty