Provider Demographics
NPI:1972992790
Name:INDEPENDENT REHAB SERVICES LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:INDEPENDENT REHAB SERVICES LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:KURILLA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPT
Authorized Official - Phone:732-822-7820
Mailing Address - Street 1:12 KACIE LYNN CT
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-4373
Mailing Address - Country:US
Mailing Address - Phone:732-822-7820
Mailing Address - Fax:732-928-8707
Practice Address - Street 1:12 KACIE LYNN CT
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-4373
Practice Address - Country:US
Practice Address - Phone:732-822-7820
Practice Address - Fax:732-928-8707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00954900251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health