Provider Demographics
NPI:1366516494
Name:TWO RIVER PHYSICAL THERAPY OF OCEAN, LLC
Entity type:Organization
Organization Name:TWO RIVER PHYSICAL THERAPY OF OCEAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:CREGLE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:732-546-7073
Mailing Address - Street 1:11 SEWARD DR
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-3724
Mailing Address - Country:US
Mailing Address - Phone:732-546-7073
Mailing Address - Fax:
Practice Address - Street 1:11 SEWARD DR
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-3724
Practice Address - Country:US
Practice Address - Phone:732-546-7073
Practice Address - Fax:732-546-7073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00646600261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ104367Medicare PIN