=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578830576
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARUSO PHYSICAL THERAPY AND NUTRITION, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2011
-----------------------------------------------------
Last Update Date | 08/31/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1278 YARDVILLE ALLENTOWN RD
-----------------------------------------------------
City | ALLENTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08501-1866
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-584-9594
-----------------------------------------------------
Fax | 609-584-9594
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1278 YARDVILLE ALLENTOWN RD
-----------------------------------------------------
City | ALLENTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08501-1866
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-584-9594
-----------------------------------------------------
Fax | 609-584-9594
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/ OWNER
-----------------------------------------------------
Name | OLIVIA ANN CARUSO
-----------------------------------------------------
Credential | MA, RDN
-----------------------------------------------------
Telephone | 609-738-3143
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 261QP2000X
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------