Provider Demographics
NPI:1801857917
Name:ATLANTIC PHYSICAL THERAPY CENTER
Entity Type:Organization
Organization Name:ATLANTIC PHYSICAL THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:MANZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-240-9296
Mailing Address - Street 1:1372 ROUTE 9
Mailing Address - Street 2:BUILDING # 2
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-4038
Mailing Address - Country:US
Mailing Address - Phone:732-240-9296
Mailing Address - Fax:732-240-9297
Practice Address - Street 1:1372 ROUTE 9
Practice Address - Street 2:BUILDING # 2
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-4038
Practice Address - Country:US
Practice Address - Phone:732-240-9296
Practice Address - Fax:732-240-9297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA084482251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0216601OtherORTHONET
NJ2648936OtherAETNA
NJ=========OtherCIGNA
NJ2648936OtherAETNA
NJ=========OtherHORIZON BCBS
NJ=========OtherGHI
NJ=========OtherHORIZON BCBS