Provider Demographics
NPI:1831575075
Name:INNER DYNAMICS PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:INNER DYNAMICS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-508-9926
Mailing Address - Street 1:1300 STATE ROUTE 35
Mailing Address - Street 2:PLAZA 2 SUITE 102
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-3537
Mailing Address - Country:US
Mailing Address - Phone:732-508-9926
Mailing Address - Fax:732-508-9928
Practice Address - Street 1:1300 STATE ROUTE 35
Practice Address - Street 2:PLAZA 2 SUITE 102
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-3537
Practice Address - Country:US
Practice Address - Phone:732-508-9926
Practice Address - Fax:732-508-9928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty