=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730314055
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOME SWEET HOME PHYSICAL THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2009
-----------------------------------------------------
Last Update Date | 06/01/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 162 JOYSAN TER
-----------------------------------------------------
City | FREEHOLD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07728-9304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-331-1654
-----------------------------------------------------
Fax | 732-359-1567
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 162 JOYSAN TER
-----------------------------------------------------
City | FREEHOLD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07728-9304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-331-1654
-----------------------------------------------------
Fax | 732-359-1567
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR/OWNER
-----------------------------------------------------
Name | EMIL MANFREDONIA
-----------------------------------------------------
Credential | MPT
-----------------------------------------------------
Telephone | 908-331-1654
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 40QA00868400
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------