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General NPI Number Information
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NPI Number | 1245569086
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Entity Type | Organization
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Legal Business Name | ADVANCED CARE PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 12/07/2009
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Last Update Date | 12/07/2009
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Provider Practice Location Address
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Address Line | 670 N BEERS ST BUILDING 1-SUITE 110
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City | HOLMDEL
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State | NJ
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Zip | 07733-1516
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Country | US
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Telephone | 732-203-0104
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Fax |
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Provider Business Mailing Address
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Address Line | 670 N BEERS ST BUILDING 1-SUITE 110
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City | HOLMDEL
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State | NJ
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Zip | 07733-1516
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Country | US
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Telephone | 732-203-0104
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GEORGE IBRAHIM
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Credential |
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Telephone | 848-248-9755
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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 | 40QA01135800
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License Number State | NJ
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