Provider Demographics
NPI:1942574439
Name:STAR PT, LLC
Entity Type:Organization
Organization Name:STAR PT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIOLETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHYC-OLESIAK
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:908-608-9200
Mailing Address - Street 1:308 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-3507
Mailing Address - Country:US
Mailing Address - Phone:908-608-9200
Mailing Address - Fax:908-608-9202
Practice Address - Street 1:308 BROAD ST
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3507
Practice Address - Country:US
Practice Address - Phone:908-608-9200
Practice Address - Fax:908-608-9202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2012-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01394500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty