=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932988557
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | R3 PHYSIOTHERAPY AND WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2023
-----------------------------------------------------
Last Update Date | 09/23/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13 FAIRVIEW AVE
-----------------------------------------------------
City | LITTLE SILVER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07739-1514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-737-7271
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1515 STATE ROUTE 35 # 1048
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07748-1829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-737-7271
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, PHYSICAL THERAPIST
-----------------------------------------------------
Name | ALEKSEY MILKE
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 732-895-0488
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------