Provider Demographics
NPI:1790338036
Name:FUNCTIONALMAX CUSTOMIZED PHYSICAL THERAPY
Entity type:Organization
Organization Name:FUNCTIONALMAX CUSTOMIZED PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ARRUFFAT
Authorized Official - Suffix:
Authorized Official - Credentials:PT DPT
Authorized Official - Phone:201-293-0753
Mailing Address - Street 1:241 W PASSAIC ST APT 10B
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662-3116
Mailing Address - Country:US
Mailing Address - Phone:646-388-4790
Mailing Address - Fax:609-435-1234
Practice Address - Street 1:241 W PASSAIC ST APT 10B
Practice Address - Street 2:
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-3116
Practice Address - Country:US
Practice Address - Phone:646-388-4790
Practice Address - Fax:609-435-1234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy