Provider Demographics
NPI:1801416359
Name:TRANSFORMATIVE PHYSICAL THERAPY & WELLNESS LLC
Entity type:Organization
Organization Name:TRANSFORMATIVE PHYSICAL THERAPY & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:THAKKAR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:212-227-3233
Mailing Address - Street 1:45 RIVER DR S APT 203
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-3701
Mailing Address - Country:US
Mailing Address - Phone:212-227-3233
Mailing Address - Fax:866-549-5687
Practice Address - Street 1:901 AVENUE C
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3012
Practice Address - Country:US
Practice Address - Phone:212-227-3233
Practice Address - Fax:866-549-5687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-24
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA01588700OtherSTATE LICENSE