=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023155769
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAJITA AND ASSOCIATES PHYSICAL THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1117 US HIGHWAY 46 SUITE 203
-----------------------------------------------------
City | CLIFTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07013-2449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-471-8110
-----------------------------------------------------
Fax | 973-471-8111
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 50205
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10305-0205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-471-8110
-----------------------------------------------------
Fax | 973-471-8111
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | SHELLA Z CAJITA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 973-471-8110
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 40QA00804600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------