Provider Demographics
NPI:1992993729
Name:PALPARK PHYSICAL THERAPY
Entity type:Organization
Organization Name:PALPARK PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGALIET
Authorized Official - Middle Name:S
Authorized Official - Last Name:THEMANS-LOSS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-568-2044
Mailing Address - Street 1:66 N VAN BRUNT ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2703
Mailing Address - Country:US
Mailing Address - Phone:201-568-2044
Mailing Address - Fax:201-568-7455
Practice Address - Street 1:103 GRAND AVE
Practice Address - Street 2:
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650
Practice Address - Country:US
Practice Address - Phone:201-242-0059
Practice Address - Fax:201-242-0352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ066739Medicare PIN