Healthcare Provider Details

I. General information

NPI: 1992323489
Provider Name (Legal Business Name): 5 POINT PHYSICAL THERAPY AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 MAIN ST STE 200A
MILLBURN NJ
07041-1181
US

IV. Provider business mailing address

4 JENNIFER LN
MAPLEWOOD NJ
07040-1365
US

V. Phone/Fax

Practice location:
  • Phone: 212-226-2066
  • Fax: 212-500-0039
Mailing address:
  • Phone: 773-991-3382
  • Fax: 212-500-0039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STACEY FUTTERMAN TAURIELLO
Title or Position: PRESIDENT
Credential: PT
Phone: 212-226-2066