Basic Information
| Provider Information | |||||||||
| NPI: | 1568052504 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ESSENTIALS PHYSICAL THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 POLERIDGE PARK | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080553353 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 1 POLERIDGE PARK | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080553353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739029848 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2021 | ||||||||
| LastUpdateDate: | 02/01/2021 | ||||||||
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| AuthorizedOfficialLastName: | ZENO | ||||||||
| AuthorizedOfficialFirstName: | ALEXANDRA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 9739029848 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT, DPT | ||||||||
| NPICertificationDate: | 02/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081S0010X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Sports Medicine |
No ID Information.