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General NPI Number Information
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NPI Number | 1588618177
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Entity Type | Organization
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Legal Business Name | CREST SPORTS TRNG PHYL THPY
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1904 ATLANTIC AVE
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City | MANASQUAN
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State | NJ
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Zip | 08736-1006
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Country | US
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Telephone | 732-212-0060
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Fax |
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Provider Business Mailing Address
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Address Line | 66 W GILBERT ST SUITE 100
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City | RED BANK
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State | NJ
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Zip | 07701-4918
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Country | US
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Telephone | 732-212-0060
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Fax | 732-212-0061
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH JOHN CALABRO
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Credential | DO
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Telephone | 732-212-0060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State | NJ
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Taxonomy #2
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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 | NJ
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