Provider Demographics
NPI:1932712262
Name:ACTIVE MOTION PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ACTIVE MOTION PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENNAWI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-647-3669
Mailing Address - Street 1:8 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9658
Mailing Address - Country:US
Mailing Address - Phone:201-647-3669
Mailing Address - Fax:
Practice Address - Street 1:623 LAFAYETTE AVE STE 101
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-2439
Practice Address - Country:US
Practice Address - Phone:201-647-3669
Practice Address - Fax:201-212-6393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy