Basic Information
| Provider Information | |||||||||
| NPI: | 1821383712 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AT HOME PT LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | AT HOME PHYSICAL THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 93 PALISADE AVE APT 2D | ||||||||
| Address2: | |||||||||
| City: | CLIFFSIDE PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070102043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5514866885 | ||||||||
| FaxNumber: | 2018408482 | ||||||||
| Practice Location | |||||||||
| Address1: | 93 PALISADE AVE APT 2D | ||||||||
| Address2: | |||||||||
| City: | CLIFFSIDE PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070102043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5514866885 | ||||||||
| FaxNumber: | 2018408482 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2011 | ||||||||
| LastUpdateDate: | 08/18/2011 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ULBRICH | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
| AuthorizedOfficialMiddleName: | ELAINE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5514866885 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | DPT | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 40QA01254700 | NJ | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.