MEDICARE: TRINITY REHAB SOMERSET PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1245789064	OTHER	NJ	BCBS

General Provider Information

NPI Number	:	1144892852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY REHAB SOMERSET PA

Provider Business Mailing Address
First Line	:	554 HIGHWAY 35
Second Line	:
City	:	RED BANK
State	:	NJ
Zip	:	07701-5066
Country	:	US
Telephone Number	:	732-219-5700
Fax Number	:	732-219-5700

Provider Business Practice Location Address
First Line	:	1460 BETHLEHEM PIKE UNIT 2
Second Line	:
City	:	NORTH WALES
State	:	PA
Zip	:	19454-2159
Country	:	US
Telephone Number	:	732-219-5700
Fax Number	:	732-334-3004

Authorized Official
Title or Position	:	AO
Name	:	TONYA GAVRIELIDES
Credential	:
Telephone Number	:	732-219-5700

Provider Enumeration Date	:	07/13/2021
Last Update Date	:	07/13/2021

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