Healthcare Provider Details

I. General information

NPI: 1851196208
Provider Name (Legal Business Name): THERAFLEX PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

749 MARIN AVE # 1
LYNDHURST NJ
07071-2521
US

IV. Provider business mailing address

749 MARIN AVE # 1
LYNDHURST NJ
07071-2521
US

V. Phone/Fax

Practice location:
  • Phone: 201-916-1681
  • Fax:
Mailing address:
  • Phone: 201-916-1681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: NATHANAEL PARK
Title or Position: OWNER, AUTHORIZED OFFICIAL, PROVIDE
Credential: P.T.A.
Phone: 201-916-1681