Healthcare Provider Details

I. General information

NPI: 1477801892
Provider Name (Legal Business Name): TRI STATE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 ELM AVENUE
HACKENSACK NJ
07661
US

IV. Provider business mailing address

17 ELM AVENUE
HACKENSACK NJ
07601
US

V. Phone/Fax

Practice location:
  • Phone: 973-633-6600
  • Fax: 973-633-1100
Mailing address:
  • Phone: 973-633-6600
  • Fax: 973-633-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00994900
License Number StateNJ

VIII. Authorized Official

Name: MR. PETER HASTINGS
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: PT
Phone: 973-633-6600