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General NPI Number Information
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NPI Number | 1568876233
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Entity Type | Organization
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Legal Business Name | INTEGRATED PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 06/20/2014
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Last Update Date | 09/22/2014
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Provider Practice Location Address
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Address Line | 860 WYCKOFF AVE UNIT 1 NW
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City | MAHWAH
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State | NJ
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Zip | 07430-3186
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Country | US
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Telephone | 201-904-2051
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Fax |
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Provider Business Mailing Address
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Address Line | 860 WYCKOFF AVE UNIT 1 NW
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City | MAHWAH
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State | NJ
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Zip | 07430-3186
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Country | US
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Telephone | 201-904-2051
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | JOHN JAY GIANNELLI
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Credential | P.T.
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Telephone | 201-904-2051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 40QA00288000
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License Number State | NJ
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