Provider Demographics
NPI:1750958690
Name:DKS INTEGRATED PHYSICAL THERAPY ASSOCIATES LLC
Entity type:Organization
Organization Name:DKS INTEGRATED PHYSICAL THERAPY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLISH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:732-850-2458
Mailing Address - Street 1:18 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-2916
Mailing Address - Country:US
Mailing Address - Phone:732-850-2458
Mailing Address - Fax:
Practice Address - Street 1:400 SWENSON DR
Practice Address - Street 2:
Practice Address - City:KENILWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07033-1323
Practice Address - Country:US
Practice Address - Phone:732-850-2458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty