Provider Demographics
NPI:1922686260
Name:KBA PHYSIO REHAB LLC
Entity Type:Organization
Organization Name:KBA PHYSIO REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KLEJDJA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERDUFI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-554-5415
Mailing Address - Street 1:322 LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-2103
Mailing Address - Country:US
Mailing Address - Phone:201-554-5415
Mailing Address - Fax:
Practice Address - Street 1:60 OWENS DRIVE
Practice Address - Street 2:INSIDE RETRO FITNESS GYM
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-0747
Practice Address - Country:US
Practice Address - Phone:973-988-5885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty