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General NPI Number Information
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NPI Number | 1760653232
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Entity Type | Organization
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Legal Business Name | THEATRE ARTS PHYSIOTHERAPY, LLC
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Dates
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Enumeration Date | 03/12/2008
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Last Update Date | 06/17/2012
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Provider Practice Location Address
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Address Line | 5 REGENT ST SUITE 503
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City | LIVINGSTON
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State | NJ
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Zip | 07039-1675
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Country | US
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Telephone | 973-422-0888
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Fax |
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Provider Business Mailing Address
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Address Line | 5 REGENT ST SUITE 503
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City | LIVINGSTON
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State | NJ
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Zip | 07039-1675
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Country | US
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Telephone | 973-422-0888
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. SIGRID SCRUGGS
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Credential |
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Telephone | 973-422-0888
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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 | 0600130702
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License Number State | NJ
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