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General NPI Number Information
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NPI Number | 1285111864
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Entity Type | Organization
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Legal Business Name | ADVANCE HOME PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 07/25/2018
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Last Update Date | 08/10/2018
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Provider Practice Location Address
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Address Line | 9 BELAIR DR
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City | FAIRFIELD
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State | NJ
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Zip | 07004
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Country | US
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Telephone | 201-390-4001
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Fax |
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Provider Business Mailing Address
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Address Line | 9 BELAIR DR
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City | FAIRFIELD
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State | NJ
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Zip | 07004-1703
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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 | FOUNDER
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Name | DR. TIFFANY LEE
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Credential | PT, DPT
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Telephone | 201-390-4001
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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 | 40QA01408100
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License Number State | NJ
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