Healthcare Provider Details

I. General information

NPI: 1235757592
Provider Name (Legal Business Name): REACTIV REHAB & RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 WARREN AVE
SPRING LAKE NJ
07762-1233
US

IV. Provider business mailing address

512 WARREN AVE
SPRING LAKE NJ
07762-1233
US

V. Phone/Fax

Practice location:
  • Phone: 347-664-5131
  • Fax: 732-813-1565
Mailing address:
  • Phone: 347-664-5131
  • Fax: 732-813-1565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DIANA DELGADO
Title or Position: BM
Credential:
Phone: 908-427-5233