=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306599006
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEVEL UP PHYSICAL THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2022
-----------------------------------------------------
Last Update Date | 02/02/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 75 E WASHINGTON AVE
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07882-1912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-857-2153
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 75 E WASHINGTON AVE
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07882-1912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-857-2153
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ALISA KAESLER
-----------------------------------------------------
Credential | MSPT
-----------------------------------------------------
Telephone | 908-334-3717
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------