Provider Demographics
NPI:1306996293
Name:JERSEY SHORE PHYSICAL THERAPY AND REHAB
Entity type:Organization
Organization Name:JERSEY SHORE PHYSICAL THERAPY AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:VISGIL
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:609-677-8778
Mailing Address - Street 1:1423 TILTON RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1857
Mailing Address - Country:US
Mailing Address - Phone:609-677-8778
Mailing Address - Fax:609-677-9229
Practice Address - Street 1:1423 TILTON RD
Practice Address - Street 2:SUITE 10
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1857
Practice Address - Country:US
Practice Address - Phone:609-677-8778
Practice Address - Fax:609-677-9229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00131700261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ091905Medicare ID - Type Unspecified