MEDICARE: THERAPY CENTER NJ LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225100000X	Physical Therapist
2	225X00000X	Occupational Therapist
3	235Z00000X	Speech-Language Pathologist
4	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1710339437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAPY CENTER NJ LLC

Provider Business Mailing Address
First Line	:	1400 PROSPECT ST
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-4611
Country	:	US
Telephone Number	:	732-367-0099
Fax Number	:	732-367-1518

Provider Business Practice Location Address
First Line	:	1400 PROSPECT ST
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-4611
Country	:	US
Telephone Number	:	732-367-0099
Fax Number	:	732-367-1518

Authorized Official
Title or Position	:	DIRECTOR
Name	:	SHANI GROSS
Credential	:
Telephone Number	:	732-367-0099

Provider Enumeration Date	:	07/06/2016
Last Update Date	:	07/06/2016

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Directions to “THERAPY CENTER NJ LLC ” Practice Location

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