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General NPI Number Information
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NPI Number | 1336338581
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Entity Type | Organization
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Legal Business Name | TOTAL BODY REHABILITATION LLC
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Dates
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Enumeration Date | 10/23/2007
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Last Update Date | 11/30/2011
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Provider Practice Location Address
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Address Line | 260 GODWIN AVE SUITE 1
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City | WYCKOFF
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State | NJ
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Zip | 07481-2099
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Country | US
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Telephone | 201-891-1155
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Fax | 201-891-5522
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Provider Business Mailing Address
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Address Line | 260 GODWIN AVE SUITE 1
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City | WYCKOFF
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State | NJ
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Zip | 07481-2099
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Country | US
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Telephone | 201-891-1155
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Fax | 201-891-5522
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Authorized Official
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Title or Position | CHIROPRACTOR / OWNER
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Name | DR. BRIAN M. SHANNON
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Credential | D. C.
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Telephone | 201-891-1155
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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