Provider Demographics
NPI:1194305888
Name:TRUE IMPACT PHYSICAL THERAPY & SPORTS REHABILITATION
Entity type:Organization
Organization Name:TRUE IMPACT PHYSICAL THERAPY & SPORTS REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEMETRIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTSIDES
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:973-598-5386
Mailing Address - Street 1:195 RT 46, SUITE 101
Mailing Address - Street 2:UNIT B
Mailing Address - City:MINE HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07803
Mailing Address - Country:US
Mailing Address - Phone:973-598-5386
Mailing Address - Fax:
Practice Address - Street 1:195 RT 46, SUITE 101
Practice Address - Street 2:UNIT B
Practice Address - City:MINE HILL
Practice Address - State:NJ
Practice Address - Zip Code:07803
Practice Address - Country:US
Practice Address - Phone:973-598-5386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-08
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty