Provider Demographics
NPI:1295008183
Name:THERAPY INTERVENTIONS AND RESOURCE AGENCY, LLC
Entity type:Organization
Organization Name:THERAPY INTERVENTIONS AND RESOURCE AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREI
Authorized Official - Middle Name:MONTEMAYOR
Authorized Official - Last Name:MANALANG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-266-4695
Mailing Address - Street 1:1777 HAMBURG TPKE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-5211
Mailing Address - Country:US
Mailing Address - Phone:862-248-0840
Mailing Address - Fax:862-248-0841
Practice Address - Street 1:1777 HAMBURG TPKE
Practice Address - Street 2:SUITE 105
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-5211
Practice Address - Country:US
Practice Address - Phone:862-248-0840
Practice Address - Fax:862-248-0841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00694800261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy