Healthcare Provider Details

I. General information

NPI: 1851935837
Provider Name (Legal Business Name): REHABILITY SPORTS MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2019
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 SOUTH ST. STE 204
FREEHOLD NJ
07728
US

IV. Provider business mailing address

83 SOUTH ST. STE 204
FREEHOLD NJ
07728
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH JIMENEZ
Title or Position: AUTHORIZED REPRESENTATIVE
Credential: MD
Phone: 732-780-6230