Basic Information
| Provider Information | |||||||||
| NPI: | 1326436585 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GAIT PHYSICAL THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 140 CHESTNUT ST | ||||||||
| Address2: | |||||||||
| City: | BELLEVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071091925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9735176501 | ||||||||
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| Practice Location | |||||||||
| Address1: | 24 BERGEN ST | ||||||||
| Address2: | |||||||||
| City: | HACKENSACK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076015482 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018806954 | ||||||||
| FaxNumber: | 2018806955 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2014 | ||||||||
| LastUpdateDate: | 09/08/2015 | ||||||||
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| AuthorizedOfficialLastName: | RAMIREZ | ||||||||
| AuthorizedOfficialFirstName: | RYAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 9735176501 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 40QA01192600 | NJ | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.