Provider Demographics
NPI:1407918600
Name:CENTER FOR PHYSICAL THERAPY & SPINAL WELLNESS, P.C.
Entity type:Organization
Organization Name:CENTER FOR PHYSICAL THERAPY & SPINAL WELLNESS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARLO
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-303-1425
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:TENNENT
Mailing Address - State:NJ
Mailing Address - Zip Code:07763-0217
Mailing Address - Country:US
Mailing Address - Phone:732-303-1425
Mailing Address - Fax:732-780-7990
Practice Address - Street 1:100 CRAIG RD
Practice Address - Street 2:SUITE 206
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8787
Practice Address - Country:US
Practice Address - Phone:732-303-1425
Practice Address - Fax:732-780-7990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00452200111N00000X
NJQA07415225100000X
NJ40QA01003200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU69128Medicare UPIN
NJ096517UT4Medicare ID - Type Unspecified