Organization Name: | PROFUNCTION PHYSICAL THERAPY LLC |
NPI Number: | 1033267323 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOSE TAN (PHYSICAL THERAPIST) |
Mailing Address: | 30 S Union Ave Cranford |
State: | NJ US |
Postal Code: | 070162833 |
Phone Number: | 9086531776 |
Fax Number: | 9086531779 |
NPI Enumeration Date: | 01/05/2007 |
NPI Last Update Date: | 04/18/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | 40QA00814100 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |