Provider Demographics
NPI:1386162832
Name:ANAKAN PHYSICAL THERAPY LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:ANAKAN PHYSICAL THERAPY LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN CARL
Authorized Official - Middle Name:PERALTA
Authorized Official - Last Name:PINEDA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:917-618-9881
Mailing Address - Street 1:77 DOTY RD
Mailing Address - Street 2:
Mailing Address - City:HASKELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07420-1431
Mailing Address - Country:US
Mailing Address - Phone:917-618-9881
Mailing Address - Fax:
Practice Address - Street 1:45 CAREY AVE STE 108
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:NJ
Practice Address - Zip Code:07405-1475
Practice Address - Country:US
Practice Address - Phone:917-618-9881
Practice Address - Fax:973-850-6850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-05
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01347600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty