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General NPI Number Information
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NPI Number | 1023158433
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Entity Type | Organization
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Legal Business Name | REHAB PRO PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 975 CLIFTON AVENUE STE 2
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City | CLIFTON
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State | NJ
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Zip | 07013
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Country | US
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Telephone | 973-773-9990
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Fax | 973-773-7772
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Provider Business Mailing Address
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Address Line | 975 CLIFTON AVENUE STE 2
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City | CLIFTON
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State | NJ
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Zip | 07013
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Country | US
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Telephone | 973-773-9990
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Fax | 973-773-7772
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Authorized Official
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Title or Position | PHYSICAL THERAPIST OWNER
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Name | ERWIN RENEGADO BANDALES
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Credential | PT
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Telephone | 973-773-9990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA00672700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA01013300
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA00655900
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License Number State | NJ
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