Provider Demographics
NPI:1811034382
Name:BROOKDALE PHYSICAL THERAPY, P. A.
Entity Type:Organization
Organization Name:BROOKDALE PHYSICAL THERAPY, P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:973-235-9585
Mailing Address - Street 1:189 FRANKLIN AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-3823
Mailing Address - Country:US
Mailing Address - Phone:973-235-9585
Mailing Address - Fax:973-235-9740
Practice Address - Street 1:189 FRANKLIN AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-3823
Practice Address - Country:US
Practice Address - Phone:973-235-9585
Practice Address - Fax:973-235-9740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00383700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty