Provider Demographics
NPI:1740532076
Name:GOOD FORM PHYSICAL THERAPY
Entity type:Organization
Organization Name:GOOD FORM PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ETHEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SARTORIO
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:908-783-9666
Mailing Address - Street 1:317 BATH AVE
Mailing Address - Street 2:UNIT 32
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-6168
Mailing Address - Country:US
Mailing Address - Phone:908-783-9666
Mailing Address - Fax:
Practice Address - Street 1:317 BATH AVE
Practice Address - Street 2:UNIT 32
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6168
Practice Address - Country:US
Practice Address - Phone:908-783-9666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy