Provider Demographics
NPI:1205078946
Name:TOTAL PHYSICAL THERAPY, LLC.
Entity type:Organization
Organization Name:TOTAL PHYSICAL THERAPY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:SYLVESTER
Authorized Official - Last Name:GARTNER
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:201-282-1142
Mailing Address - Street 1:25 E. SPRING VALLEY AVE
Mailing Address - Street 2:SUITE 190
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607
Mailing Address - Country:US
Mailing Address - Phone:201-820-4604
Mailing Address - Fax:201-820-4605
Practice Address - Street 1:25 E. SPRING VALLEY AVE
Practice Address - Street 2:SUITE 190
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607
Practice Address - Country:US
Practice Address - Phone:201-820-4604
Practice Address - Fax:201-820-4605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00928200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
11804691OtherCAQH