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General NPI Number Information
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NPI Number | 1619170040
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Entity Type | Organization
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Legal Business Name | PROACTIVE SPORTS CARE AND REHABILITATION,PC
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Dates
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Enumeration Date | 06/05/2007
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Last Update Date | 05/02/2013
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Provider Practice Location Address
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Address Line | 160 WHITE RD SUITE 104
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City | LITTLE SILVER
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State | NJ
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Zip | 07739-1165
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Country | US
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Telephone | 732-933-3570
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Fax |
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Provider Business Mailing Address
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Address Line | 160 WHITE RD SUITE 104
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City | LITTLE SILVER
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State | NJ
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Zip | 07739-1165
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Country | US
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Telephone | 732-933-3570
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CHRISTINE ANNE LARGEY
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Credential | PT
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Telephone | 732-933-3570
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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 |
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License Number State |
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