Provider Demographics
NPI:1669768735
Name:LIBERTY PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:LIBERTY PHYSICAL THERAPY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ INCORPORATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHITRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITTAL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MHS, OCS, CSCS
Authorized Official - Phone:201-366-1115
Mailing Address - Street 1:115 CHRISTOPHER COLUMBUS DR STE 300
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-3551
Mailing Address - Country:US
Mailing Address - Phone:201-366-1115
Mailing Address - Fax:
Practice Address - Street 1:115 CHRISTOPHER COLUMBUS DR STE 300
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-3551
Practice Address - Country:US
Practice Address - Phone:317-427-3310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty