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General NPI Number Information
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NPI Number | 1497894968
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL SPORTS & ORTHOPAEDIC REHABILITATION ASSOCIATES, LLC
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 08/14/2012
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Provider Practice Location Address
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Address Line | 455 US HIGHWAY 9 CO GAME SHAPE
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City | MANALAPAN
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State | NJ
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Zip | 07726-8274
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Country | US
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Telephone | 732-617-8090
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Fax | 732-972-5458
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Provider Business Mailing Address
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Address Line | 455 US HIGHWAY 9 CO GAME SHAPE
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City | MANALAPAN
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State | NJ
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Zip | 07726-8274
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Country | US
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Telephone | 732-617-8090
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Fax | 732-972-5458
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Authorized Official
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Title or Position | OWNER DIRETOR
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Name | MISS MICHELLE E. WOLPOV
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Credential | PT
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Telephone | 732-617-8090
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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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