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General NPI Number Information
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NPI Number | 1073939856
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Entity Type | Organization
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Legal Business Name | ASCEND PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 03/17/2014
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Last Update Date | 06/03/2014
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Provider Practice Location Address
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Address Line | 119 GROVE ST # 1
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City | MONTCLAIR
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State | NJ
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Zip | 07042-4044
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Country | US
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Telephone | 973-744-3561
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Fax |
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Provider Business Mailing Address
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Address Line | 119 GROVE ST #1
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City | MONTCLAIR
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State | NJ
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Zip | 07042-4044
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MR. SHANE MCCLAFFERTY
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Credential |
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Telephone | 973-744-3561
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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 | 40QA00437900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 273Y00000X
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Taxonomy Name | Rehabilitation Hospital Unit
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License Number | 40QA00437900
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License Number State | NJ
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