Basic Information
| Provider Information | |||||||||
| NPI: | 1235350265 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FRANKLIN LAKES PHYSICAL THERAPY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 795 FRANKLIN AVE | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN LAKES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074171368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018478585 | ||||||||
| FaxNumber: | 2018470985 | ||||||||
| Practice Location | |||||||||
| Address1: | 795 FRANKLIN AVE | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN LAKES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074171368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018478585 | ||||||||
| FaxNumber: | 2018470985 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 12/01/2011 | ||||||||
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| AuthorizedOfficialLastName: | RAMSEY | ||||||||
| AuthorizedOfficialFirstName: | KATRIN | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2018478585 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DSC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA00336800 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 184896 | 01 | NJ | PTAN | OTHER |