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General NPI Number Information
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NPI Number | 1124413505
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Entity Type | Organization
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Legal Business Name | PREMIER THERAPY SERVICES
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Dates
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Enumeration Date | 04/01/2015
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Last Update Date | 04/01/2015
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Provider Practice Location Address
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Address Line | 5 BOROLINE RD
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City | SADDLE RIVER
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State | NJ
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Zip | 07458-2343
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Country | US
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Telephone | 201-818-8680
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Fax |
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Provider Business Mailing Address
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Address Line | 5 BOROLINE RD
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City | SADDLE RIVER
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State | NJ
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Zip | 07458-2343
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Country | US
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Telephone | 201-818-8680
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | ISAO KITAGUCHI
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Credential | OTR
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Telephone | 201-681-2581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | 46TR00669800
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License Number State | NJ
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