Provider Demographics
NPI:1801425178
Name:AT-HOME PHYSICAL THERAPY & FITNESS
Entity type:Organization
Organization Name:AT-HOME PHYSICAL THERAPY & FITNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:F
Authorized Official - Last Name:MALONEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:757-727-3699
Mailing Address - Street 1:39 WINDSOR CT
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-6747
Mailing Address - Country:US
Mailing Address - Phone:732-301-4696
Mailing Address - Fax:
Practice Address - Street 1:39 WINDSOR CT
Practice Address - Street 2:
Practice Address - City:NEPTUNE CITY
Practice Address - State:NJ
Practice Address - Zip Code:07753-6747
Practice Address - Country:US
Practice Address - Phone:732-301-4696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA01893100OtherNJ PT LICENSE
NJ40QA01897500OtherNJ PT LICENSE