Healthcare Provider Details

I. General information

NPI: 1376604041
Provider Name (Legal Business Name): THERAPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 08/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

763 CONVERY BLVD
PERTH AMBOY NJ
08861-2525
US

IV. Provider business mailing address

763 CONVERY BLVD
PERTH AMBOY NJ
08861-2525
US

V. Phone/Fax

Practice location:
  • Phone: 732-442-1170
  • Fax: 732-442-1175
Mailing address:
  • Phone: 732-442-1170
  • Fax: 732-442-1175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00466900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00561900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01253900
License Number StateNJ

VIII. Authorized Official

Name: DR. THOMAS E. HARY
Title or Position: CLINIC DIRECTOR
Credential: D.C.
Phone: 732-442-1170