Provider Demographics
NPI:1720643372
Name:SPINECK PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:SPINECK PHYSICAL THERAPY LLC
Other - Org Name:SPINECK PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DEVANSHI
Authorized Official - Middle Name:
Authorized Official - Last Name:MODI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:551-208-3234
Mailing Address - Street 1:646 ROUTE 18 NORTH STE 110 BLDG B
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3722
Mailing Address - Country:US
Mailing Address - Phone:551-208-3234
Mailing Address - Fax:
Practice Address - Street 1:646 ROUTE 18 NORTH
Practice Address - Street 2:SUITE 110, BLDG B
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816
Practice Address - Country:US
Practice Address - Phone:551-208-3234
Practice Address - Fax:855-282-5632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-08
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy