Provider Demographics
NPI:1245676451
Name:AT HOME VISITING THERAPY
Entity type:Organization
Organization Name:AT HOME VISITING THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMAIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:973-800-4606
Mailing Address - Street 1:49 UNION ST
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3320
Mailing Address - Country:US
Mailing Address - Phone:973-800-4606
Mailing Address - Fax:
Practice Address - Street 1:19 VALHALLA WAY
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-2328
Practice Address - Country:US
Practice Address - Phone:844-697-8669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA01039100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty