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General NPI Number Information
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NPI Number | 1518017144
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Entity Type | Organization
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Legal Business Name | JAG-ONE PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 08/06/2019
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Provider Practice Location Address
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Address Line | 622 EAGLE ROCK AVE
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City | WEST ORANGE
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State | NJ
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Zip | 07052-2994
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Country | US
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Telephone | 973-669-0078
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Fax | 973-669-1113
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Provider Business Mailing Address
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Address Line | 622 EAGLE ROCK AVE
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City | WEST ORANGE
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State | NJ
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Zip | 07052-2994
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Country | US
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Telephone | 973-669-0078
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Fax | 973-669-1113
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Authorized Official
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Title or Position | OWNER
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Name | JOHN ANTHONY GALLUCCI JR.
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Credential | MSPT
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Telephone | 973-669-0078
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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 | 40QA01172700
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License Number State | NJ
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