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General NPI Number Information
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NPI Number | 1003932880
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Entity Type | Organization
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Legal Business Name | PRESTIGE PHYSICAL THERAPY, L.L.C.
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 01/31/2011
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Provider Practice Location Address
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Address Line | 463 LIVINGSTON ST SUITE 203
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City | NORWOOD
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State | NJ
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Zip | 07648-1344
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Country | US
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Telephone | 201-921-7766
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Fax |
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Provider Business Mailing Address
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Address Line | 199 MANITO AVE
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City | OAKLAND
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State | NJ
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Zip | 07436-4013
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Country | US
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Telephone | 201-921-7766
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. KEITH ALLEN ROGERS
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Credential | P.T.
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Telephone | 201-921-7766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 40QA00966100
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License Number State | NJ
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