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General NPI Number Information
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NPI Number | 1689413486
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Entity Type | Organization
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Legal Business Name | ORTHOPRO PHYSICAL THERAPY NJ LLC
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Dates
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Enumeration Date | 05/21/2024
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Last Update Date | 06/26/2024
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Provider Practice Location Address
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Address Line | 66 W MOUNT PLEASANT AVE STE 205
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City | LIVINGSTON
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State | NJ
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Zip | 07039-2930
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Country | US
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Telephone | 973-699-0599
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Fax | 646-357-3577
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Provider Business Mailing Address
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Address Line | 14 FAWN DR
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City | LIVINGSTON
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State | NJ
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Zip | 07039-1916
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Country | US
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Telephone | 973-699-0599
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Fax | 646-357-3577
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Authorized Official
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Title or Position | OWNER
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Name | DIANA MAYANTS
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Credential | PT, DPT, OCS, CMPT
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Telephone | 973-699-0599
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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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