=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083375356
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALIGN CARE PHYSICAL THERAPY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2022
-----------------------------------------------------
Last Update Date | 01/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 636A 6TH STREET CARLSTADT,
-----------------------------------------------------
City | CARLSTADT
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-615-7539
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 636A 6TH STREET CARLSTADT,
-----------------------------------------------------
City | CARLSTADT
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-615-7539
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NICKY S SHAH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 706-615-7539
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------