Healthcare Provider Details

I. General information

NPI: 1952922304
Provider Name (Legal Business Name): NEW JERSEY LUNA CARE PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2020
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 UNIVERSITY PLZ STE 100
HACKENSACK NJ
07601-6210
US

IV. Provider business mailing address

PO BOX 2350
ROCKLIN CA
95677-8350
US

V. Phone/Fax

Practice location:
  • Phone: 877-839-6979
  • Fax: 833-817-7128
Mailing address:
  • Phone: 866-806-3599
  • Fax: 833-817-7128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: CLARISA ODELL
Title or Position: MANAGER
Credential:
Phone: 866-806-3599