Provider Demographics
NPI:1104309988
Name:RETURN2SPORT
Entity type:Organization
Organization Name:RETURN2SPORT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:GERDES
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:732-979-6965
Mailing Address - Street 1:2260 LANDMARK PL
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1025
Mailing Address - Country:US
Mailing Address - Phone:732-800-1078
Mailing Address - Fax:
Practice Address - Street 1:2260 LANDMARK PL
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1025
Practice Address - Country:US
Practice Address - Phone:732-800-1078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-08
Last Update Date:2020-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty