Provider Demographics
NPI:1861839391
Name:CORE PHYSICAL THERAPY AND WELLNESS, LLC
Entity Type:Organization
Organization Name:CORE PHYSICAL THERAPY AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:J
Authorized Official - Last Name:QUIJANO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-844-0090
Mailing Address - Street 1:251 ROCK RD FL 2
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-1745
Mailing Address - Country:US
Mailing Address - Phone:201-844-0090
Mailing Address - Fax:201-445-0919
Practice Address - Street 1:251 ROCK RD FL 2
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-1745
Practice Address - Country:US
Practice Address - Phone:201-844-0090
Practice Address - Fax:201-445-0919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty