=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710192406
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRANQUILITY PHYSICAL THERAPY & ACUPUNCTURE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2007
-----------------------------------------------------
Last Update Date | 04/24/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 134 JAMES ST
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07960-5903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-650-6165
-----------------------------------------------------
Fax | 973-540-9003
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 134 JAMES ST
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07960-5903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-650-6165
-----------------------------------------------------
Fax | 973-540-9003
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DIANE LETTIERE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 201-650-6165
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number | 40QA00296000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------