Provider Demographics
NPI:1245811926
Name:EXCLUSIVE SPORTS & REHAB LLC
Entity type:Organization
Organization Name:EXCLUSIVE SPORTS & REHAB LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:YANIRDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEJIA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS, COMT
Authorized Official - Phone:862-571-0200
Mailing Address - Street 1:5 W PASSAIC ST STE 2B
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662-3224
Mailing Address - Country:US
Mailing Address - Phone:201-375-6935
Mailing Address - Fax:201-375-6936
Practice Address - Street 1:5 W PASSAIC ST STE 2B
Practice Address - Street 2:
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-3224
Practice Address - Country:US
Practice Address - Phone:201-375-6935
Practice Address - Fax:201-375-6935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty