Provider Demographics
NPI:1962425314
Name:PRO PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:PRO PHYSICAL THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:E
Authorized Official - Last Name:DEVINCENTIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:973-895-9925
Mailing Address - Street 1:2 EMERY AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-1368
Mailing Address - Country:US
Mailing Address - Phone:973-895-9925
Mailing Address - Fax:973-895-9927
Practice Address - Street 1:2 EMERY AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-1368
Practice Address - Country:US
Practice Address - Phone:973-895-9925
Practice Address - Fax:973-895-9927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ023997Medicare ID - Type Unspecified