Provider Demographics
NPI:1649925173
Name:RESILIENT PERFORMANCE PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:RESILIENT PERFORMANCE PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAPPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-824-5130
Mailing Address - Street 1:148 COLLEGE PL
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2506
Mailing Address - Country:US
Mailing Address - Phone:309-824-5130
Mailing Address - Fax:
Practice Address - Street 1:315 MIDDLESEX RD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4316
Practice Address - Country:US
Practice Address - Phone:929-429-5086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy