Provider Demographics
NPI:1891370235
Name:GEORGE, TREVOR JAMES (DPT)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:JAMES
Last Name:GEORGE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:POMPTON LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07442-1913
Mailing Address - Country:US
Mailing Address - Phone:973-997-5612
Mailing Address - Fax:
Practice Address - Street 1:8 TOWN CENTER DR STE 1
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1989
Practice Address - Country:US
Practice Address - Phone:973-726-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01990500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist