Basic Information
| Provider Information | |||||||||
| NPI: | 1831660323 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JAG-ONE PHYSICAL THERAPY, LLC | ||||||||
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| OtherOrganizationName: | JAG PHYSICAL THERAPY LLC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 ROUTE 9 N | ||||||||
| Address2: | |||||||||
| City: | WOODBRIDGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070951025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018017141 | ||||||||
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| Practice Location | |||||||||
| Address1: | 461 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CHATHAM | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079282102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9736351000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2018 | ||||||||
| LastUpdateDate: | 08/06/2019 | ||||||||
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| AuthorizedOfficialLastName: | TEETSELL | ||||||||
| AuthorizedOfficialFirstName: | LUANN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7188445350 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | N | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | 225X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.