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General NPI Number Information
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NPI Number | 1851935837
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Entity Type | Organization
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Legal Business Name | REHABILITY SPORTS MEDICINE, LLC
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Dates
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Enumeration Date | 11/01/2019
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Last Update Date | 11/01/2019
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Provider Practice Location Address
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Address Line | 83 SOUTH ST. STE 204
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City | FREEHOLD
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State | NJ
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Zip | 07728
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Country | US
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Telephone | 732-780-6230
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Fax | 732-780-6232
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Provider Business Mailing Address
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Address Line | 83 SOUTH ST. STE 204
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City | FREEHOLD
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State | NJ
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Zip | 07728
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Country | US
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Telephone | 732-780-6230
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED REPRESENTATIVE
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Name | DR. JOSEPH JIMENEZ
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Credential | MD
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Telephone | 732-780-6230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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