=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427207752
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRINITY PHYSICAL THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2008
-----------------------------------------------------
Last Update Date | 03/18/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 FULTON RD
-----------------------------------------------------
City | SOMERSET
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08873-2326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-246-2536
-----------------------------------------------------
Fax | 732-246-0428
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 FULTON RD
-----------------------------------------------------
City | SOMERSET
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08873-2326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-246-2536
-----------------------------------------------------
Fax | 732-246-0428
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DIRECTOR
-----------------------------------------------------
Name | DR. ABIMBOLA O FADAHUNSI
-----------------------------------------------------
Credential | P T
-----------------------------------------------------
Telephone | 908-295-9093
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 40QA00599300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------