Provider Demographics
NPI:1982870374
Name:THERAPEUTIC FITNESS OF TEANECK LLC
Entity Type:Organization
Organization Name:THERAPEUTIC FITNESS OF TEANECK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:HANNAH
Authorized Official - Last Name:KAY
Authorized Official - Suffix:
Authorized Official - Credentials:0TR/L, WITS
Authorized Official - Phone:718-753-7655
Mailing Address - Street 1:573 WARWICK AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2928
Mailing Address - Country:US
Mailing Address - Phone:718-753-7655
Mailing Address - Fax:201-357-4395
Practice Address - Street 1:1415 QUEEN ANNE RD
Practice Address - Street 2:204
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3521
Practice Address - Country:US
Practice Address - Phone:718-753-7655
Practice Address - Fax:201-357-4395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00129200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty