Healthcare Provider Details

I. General information

NPI: 1831335694
Provider Name (Legal Business Name): GLEN ROCK PHYSICAL THERAPY AND SPORTS REHABILITATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2008
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 ROCK RD FL 2
GLEN ROCK NJ
07452-1745
US

IV. Provider business mailing address

251 ROCK RD STE 2C
GLEN ROCK NJ
07452-1797
US

V. Phone/Fax

Practice location:
  • Phone: 201-445-0900
  • Fax: 201-445-0919
Mailing address:
  • Phone: 201-445-0900
  • Fax: 201-445-0919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number40QA01083300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAUL M ARTALE
Title or Position: OWNER
Credential: P.T.
Phone: 201-445-0900