Healthcare Provider Details

I. General information

NPI: 1427426485
Provider Name (Legal Business Name): ULTIMA REHAB-NJ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2015
Last Update Date: 09/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 NEW JERSEY AVE
WALL TOWNSHIP NJ
07719-4519
US

IV. Provider business mailing address

826 HIGHLAND AVE
MORRISVILLE PA
19067-1071
US

V. Phone/Fax

Practice location:
  • Phone: 610-590-1385
  • Fax: 267-790-0402
Mailing address:
  • Phone: 610-590-1385
  • Fax: 267-790-0402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: AUSTIN DUUS
Title or Position: CFO
Credential:
Phone: 609-509-2388