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General NPI Number Information
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NPI Number | 1710079454
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Entity Type | Organization
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Legal Business Name | SPARTA ORTHOPEDIC & SPORTS PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 07/28/2016
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Provider Practice Location Address
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Address Line | 57 SPARTA AVE
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City | SPARTA
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State | NJ
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Zip | 07871-1822
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Country | US
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Telephone | 973-726-0111
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Fax | 973-726-0399
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Provider Business Mailing Address
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Address Line | 57 SPARTA AVE
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City | SPARTA
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State | NJ
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Zip | 07871-1822
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Country | US
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Telephone | 973-726-0111
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Fax | 973-726-0399
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Authorized Official
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Title or Position | PRESIDENT PHYSICAL THERAPIST
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Name | MR. SCOTT C THEURET
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Credential | RPT
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Telephone | 973-726-0111
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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 | 40QA01006600
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License Number State | NJ
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