MEDICARE: PRO-ACTIVITY REHABILITATION ASSOCIATES, LLC

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1457356735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRO-ACTIVITY REHABILITATION ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	1250 STATE ROUTE 31 STE 100
Second Line	:
City	:	LEBANON
State	:	NJ
Zip	:	08833-3238
Country	:	US
Telephone Number	:	908-730-6640
Fax Number	:	908-730-0468

Provider Business Practice Location Address
First Line	:	1250 STATE ROUTE 31
Second Line	:
City	:	LEBANON
State	:	NJ
Zip	:	08833-3238
Country	:	US
Telephone Number	:	908-730-6640
Fax Number	:	908-730-0468

Authorized Official
Title or Position	:	DIRECTOR OF CLINICAL OPERATIONS
Name	:	DR. JUSTIN SCOTT BAGLEY
Credential	:	PT, DPT
Telephone Number	:	908-730-6640

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	12/03/2020

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