Provider Demographics
NPI:1134800931
Name:PERFORMING ARTS PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:PERFORMING ARTS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:NEGRON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:908-380-2549
Mailing Address - Street 1:415 ROUTE 34 STE 108
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-2523
Mailing Address - Country:US
Mailing Address - Phone:732-858-1335
Mailing Address - Fax:723-201-4563
Practice Address - Street 1:415 ROUTE 34 STE 108
Practice Address - Street 2:
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-2523
Practice Address - Country:US
Practice Address - Phone:732-858-1335
Practice Address - Fax:723-201-4563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty