Provider Demographics
NPI:1831335694
Name:GLEN ROCK PHYSICAL THERAPY AND SPORTS REHABILITATION, INC
Entity type:Organization
Organization Name:GLEN ROCK PHYSICAL THERAPY AND SPORTS REHABILITATION, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:ARTALE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-445-0900
Mailing Address - Street 1:251 ROCK RD STE 2C
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-1797
Mailing Address - Country:US
Mailing Address - Phone:201-445-0900
Mailing Address - Fax:201-445-0919
Practice Address - Street 1:251 ROCK RD FL 2
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-1745
Practice Address - Country:US
Practice Address - Phone:201-445-0900
Practice Address - Fax:201-445-0919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0400X
NJ40QA01083300261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation