Healthcare Provider Details

I. General information

NPI: 1447379177
Provider Name (Legal Business Name): REHABILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 02/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 SOUTH ST STE 204
FREEHOLD NJ
07728-2491
US

IV. Provider business mailing address

83 SOUTH ST STE 204
FREEHOLD NJ
07728-2491
US

V. Phone/Fax

Practice location:
  • Phone: 732-780-6230
  • Fax: 732-780-6232
Mailing address:
  • Phone: 732-780-6230
  • Fax: 732-780-6232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00653500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT CHICKARA
Title or Position: DIRECTOR
Credential:
Phone: 732-780-6230