Provider Demographics
NPI:1396376927
Name:RE-ACTIVE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:RE-ACTIVE PHYSICAL THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:POONAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-744-3924
Mailing Address - Street 1:900 EASTON AVE STE 22
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1760
Mailing Address - Country:US
Mailing Address - Phone:732-846-9400
Mailing Address - Fax:732-846-9404
Practice Address - Street 1:900 EASTON AVE STE 22
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1760
Practice Address - Country:US
Practice Address - Phone:732-846-9400
Practice Address - Fax:732-846-9404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-02
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty