Provider Demographics
NPI:1205509965
Name:TRINITY PHYSICAL THERAPY AND REHAB CENTER PC
Entity type:Organization
Organization Name:TRINITY PHYSICAL THERAPY AND REHAB CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ENGY
Authorized Official - Middle Name:
Authorized Official - Last Name:KERIACOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-778-2020
Mailing Address - Street 1:305 BAYONNE CROSSING WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-5304
Mailing Address - Country:US
Mailing Address - Phone:201-778-2020
Mailing Address - Fax:
Practice Address - Street 1:305 BAYONNE CROSSING WAY STE 101
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-5304
Practice Address - Country:US
Practice Address - Phone:201-778-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Multi-Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty