Provider Demographics
NPI:1750813655
Name:ANCHORAGE PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:ANCHORAGE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:PULEIO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:732-228-7273
Mailing Address - Street 1:1747 HOOPER AVE STE 15
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-8165
Mailing Address - Country:US
Mailing Address - Phone:732-228-7273
Mailing Address - Fax:
Practice Address - Street 1:1747 HOOPER AVE STE 15
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-8165
Practice Address - Country:US
Practice Address - Phone:732-228-7273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00966700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty