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General NPI Number Information
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NPI Number | 1598151185
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Entity Type | Organization
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Legal Business Name | TIER 1 DIRECT PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 04/09/2015
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Last Update Date | 04/27/2015
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Provider Practice Location Address
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Address Line | 330 CONGERS AVE
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City | NORTHVALE
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State | NJ
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Zip | 07647-1607
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Country | US
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Telephone | 201-543-4078
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Fax | 201-784-1401
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Provider Business Mailing Address
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Address Line | 330 CONGERS AVE
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City | NORTHVALE
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State | NJ
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Zip | 07647-1607
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Country | US
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Telephone | 201-543-4078
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Fax | 201-784-1401
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | DR. VINCENT GARY DIPERSIA
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Credential | PT, DPT, OCS, CAMT
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Telephone | 201-543-4078
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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 | 40QA01198100
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License Number State | NJ
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