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General NPI Number Information
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NPI Number | 1770025157
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Entity Type | Organization
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Legal Business Name | BRIGANTINE PHYSICAL THERAPY AND FITNESS LLC
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Dates
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Enumeration Date | 11/16/2016
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Last Update Date | 12/08/2016
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Provider Practice Location Address
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Address Line | 3103 W BRIGANTINE AVE
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City | BRIGANTINE
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State | NJ
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Zip | 08203-1655
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Country | US
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Telephone | 302-373-3767
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Fax |
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Provider Business Mailing Address
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Address Line | 312 S 26TH ST
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City | BRIGANTINE
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State | NJ
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Zip | 08203-1845
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Country | US
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Telephone | 302-373-3767
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | PAUL DANAHER
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Credential |
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Telephone | 302-373-3767
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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 | 40QA01663000
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License Number State | NJ
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