Healthcare Provider Details

I. General information

NPI: 1447821046
Provider Name (Legal Business Name): ALLY PHYSICAL THERAPY,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2021
Last Update Date: 07/09/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 LEMOINE AVE STE 204
FORT LEE NJ
07024-6210
US

IV. Provider business mailing address

2463 8TH ST
FORT LEE NJ
07024-3521
US

V. Phone/Fax

Practice location:
  • Phone: 201-282-8236
  • Fax:
Mailing address:
  • Phone: 201-282-8236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LIBERTY YOUNG
Title or Position: PHYSICAL THERAPIST
Credential: PT,DPT,OCS
Phone: 201-282-8236