Provider Demographics
NPI:1972982643
Name:MENS PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:MENS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:
Authorized Official - Last Name:NASR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-290-1590
Mailing Address - Street 1:255 W SPRING VALLEY AVE
Mailing Address - Street 2:109
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-1445
Mailing Address - Country:US
Mailing Address - Phone:201-290-1590
Mailing Address - Fax:212-731-0267
Practice Address - Street 1:255 W SPRING VALLEY AVE
Practice Address - Street 2:109
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-1445
Practice Address - Country:US
Practice Address - Phone:201-290-1590
Practice Address - Fax:212-731-0267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-27
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty