| Organization Name: | MGT PHYSICAL THERAPY LLC |
| NPI Number: | 1033547005 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | EDUARDO MAURICIO TRUJILLO (PHYSICAL THERAPIST) |
| Mailing Address: | 112 N Broadway Apt E South Amboy |
| State: | NJ US |
| Postal Code: | 088791675 |
| Phone Number: | 7326091547 |
| Fax Number: | |
| NPI Enumeration Date: | 10/29/2013 |
| NPI Last Update Date: | 10/29/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 320700000X |
| License Number: | 40QAO1259300 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Residential Treatment Facility, Physical Disabilities |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |